There are many forms of depression, and a whole range of degrees of severity of this mental condition. Cardiac depression is some form of depression that occurs after a heart event, such as a heart attack or heart surgery. There are many resources out there on this topic, but I found one to be very useful, and that is an interview on the Patient Power website with Dr. Kim Lebowitz of Northwestern Memorial Hospital. I highly recommend listening to the interview or reading the transcript.
“When you look at the cardiac population as many as 20 to 40 percent of cardiac patients are going to be presenting with symptoms of clinical depression, and that might be compared to about 4 percent of the general population at any one given time having symptoms of depression.” -Lebowitz
Dr. Lebowitz explains that the presence of depressive symptoms after that cardiac event can actually predict a poorer outcome for a patient, which means that depression is an independent risk factor for both the development of heart disease and cardiac outcomes following a heart attack or cardiac surgery. Basically, depression can cause (increase) heart disease, and heart disease can cause depression.
That sure does sound like a vicious cycle. Why am I discussing this? Because I have experienced first hand (on the lower end of the spectrum) some symptoms of cardiac depression. For me, it is easy to be positive in writing, like on this blog, on Facebook, or on posts at supportnetwork.heart.org/heartvalvedisease. I think these outlets have definitely aided in my overall outlook, which I will mention again later. That does not mean though, that I am not struggling with some symptoms of cardiac related depression. I would not say that I am depressed, but I have tasted the bitterness of some of the symptoms. I feel that I am taking positive steps (described below), but the effect of only a few symptoms have been very difficult for me. Imagine what someone who has full blown cardiac depression is going through.
So what does Dr. Lebowitz say & recommend?
- Having a range of emotions or strong emotions does not mean you are depressed. It is healthy to express all sorts of emotions.
- An individual with clinical depression will display a number of symptoms that cluster together that may cause the individual with distress or impairment to their daily life. These symptoms are:
- Sadness or a loss of interest or pleasure in most activities.
- Difficulty sleeping or an increase/ decrease of sleep.
- An increase or decrease of appetite.
- Cognitive changes: Feeling hopeless, worthless, guilt, trouble concentrating or focusing, feeling sad or down, and most importantly, feelings of suicide.
- Decrease in motivation in things, such as a decrease in sexual functioning.
- Depression is treatable and the treatment for depression is safe for cardiac patients and that effective treatment can improve their quality of life.
- Not all pharmacological treatments are necessarily safe for heart patients. Antidepressants called SSRIs (selective serotonin reuptake inhibitors) have been found to be safe for most heart patients.
- Therapy, predominantly cognitive behavioral therapy is another form of treatment.
Friends and family actually have a powerful role in reducing cardiac depression. The following steps can be taken by friends and family.
- The first step is to recognize the symptoms listed above.
- To decrease depressive symptoms, increase recreational activities. Initiating activities is the hardest part for patients. Friends & family members should encourage activities and participate with the patient.
- Friends and family play the role of cheerleaders. It’s helpful to have someone point out how far they’ve come and everything they’ve accomplished.
- Friends and family may need to sometimes abandon their cheerleader mode, and simply acknowledge the patient’s frustrations and varying emotions. e.g. ‘Yeah, I know that this is hard and this is difficult and I understand.’
It appears that Dr. Lebowitz is from only a handful of healthcare professionals actually dealing with this issue with real patients at a cardiac hospital. What that means to me is that it is up to us (the patients) and their families to identify this condition, take active steps to alleviate the symptoms, and to report it to our cardiologists, primary care physicians, and mental health professionals.
While I recover from my 2nd open heart surgery, what am I doing to eliminate these symptoms and to stay positive?
- Bonsai & gardening.
- Frequently walking around town with my dog Moon.
- Finding new music.
- Watching a new show (Dexter).
- Meeting friends for coffee.
- Being creative by doing art projects
- Reading books & comic books.
- Going on trips with friends.
- Talking to mom on the phone.
See proof below.