When a person has a heart attack, stroke, or heart surgery, their physical recovery takes centre stage.
However, it is also important for doctors and caregivers to monitor the emotional changes that follow the ordeal of a cardiac event, or even discovery of heart trouble. Because, sometimes, bouncing back emotionally turns out to be a lot harder than recuperating physically, due to the underlying threat of extreme sadness and mental fatigue that could build into full-blown depression.
For instance, when rehabilitating someone who has undergone coronary bypass surgery, the focus is on rebuilding and strengthening weakened muscles. While temporary feelings of sadness are normal, and should go away within a few weeks, some patients stay depressed. The exact cause is unknown, but experts are considering several — prolonged time under anaesthesia, hypothermia, or the psychological upheaval of serious illness and impending surgery.
Heart health and mental health are intertwined
Depression is not merely a post-operative concern in case of heart patients. Research has shown that depression can in fact be a predisposing factor for coronary heart disease (CHD), just like smoking, high cholesterol levels and high blood pressure. People with severe mental health problems are two to three times more likely to suffer from CHD due to medication and lifestyle factors. Depression may lead to chronically high levels of stress hormones cortisol and adrenaline, which are part of the “fight or flight” response. This can negatively impact the heart over time. In addition, significant psychological distress may cause a rapid heartbeat, high blood pressure, elevated insulin levels, worsened cholesterol levels. Thus heart disease and depression can feed one another in several ways.
Depression can trigger a set of behaviours detrimental to heart health
Depression can make cardiac rehab a major challenge. Lack of energy, classic fallout of depression, makes it very challenging to begin and stick to an exercise regimen. Depressed individuals may not always adhere to their prescribed post-op medications either, on the contrary, they may be more likely to consume alcohol, junk food, overindulge or smoke. Such behaviours slow down post-op recovery to a great extent.
Taking control of the depression can positively impact heart health
Heart patients can significantly improve their odds by making lifestyle changes that positively impact their mental, physical and heart health. To begin with, switching to a healthier diet can elevate mood, curb unhealthy food cravings and help in weight, blood pressure and cholesterol management. In addition, stepping up the physical activity can promote weight loss, enhance strength, improve sleep quality and generate an overall sense of well-being.
Mood-altering substances like alcohol are best kept at arm’s length. Alcohol, though consumed with the hope of helping one cope with a problem, can rapidly worsen mood and make the condition worse, setting off a downward spiral.
If you’re a cardiac patient:
Talk to your doctor if you experience 3 or more symptoms of depression—such as low energy, low interest in activities previously enjoyed, lack of sleep, inability to go through normal day-to-day routines for longer than three weeks after surgery or diagnosis. Also reach out if you feel your recovery, your work or family life is affected, or if you feel this way after taking a particular medication. In this case, a conversation with your physician is important to stop or switch medications.
Dr Piers Clifford is an Interventional cardiologist with the Buckinghamshire Hospitals NHS trust. He has vast experience in all areas of adult cardiology and a special interest in coronary intervention, modern treatment of hypertension, atrial fibrillation and inherited cardiomyopathies. He lives in central London, plays competitive tennis, enjoys good food and fine wine, and likes to spend as much time as possible in the mountains.