Dear Doctor Column, April 20, 2009

Depression After Heart Attack Common and Serious

Question:

My husband had a heart attack two months ago, and I think he is depressed. Is this common? Should he tell his doctor?

Answer:

Depression after a heart attack is quite common, and yes, he should tell his doctor that he’s feeling depressed. Information about his symptoms will help his doctor predict his risk of future problems, and treatment will help him feel better and return to the activities he enjoys sooner.

One fifth of patients hospitalized for heart attack experience major depression, and 65% of patients report feeling some symptoms of depression. Symptoms can start immediately, a few days after the heart attack, or several weeks or even months later.

Symptoms to look for include:

• overwhelming feelings of sadness
• loss of interest or pleasure in activities that the individual usually enjoys
• weight loss or gain
• trouble sleeping
• fatigue or low energy
• feelings of worthlessness, guilt, hopelessness
• trouble thinking or concentrating
• loss of sexual desire

Doctors do not fully understand why heart attacks cause depression in many people. Some medications, such as beta blockers, can cause depression. Experiencing a heart attack can understandably lead individuals to think about their mortality, to worry about their family, and to put off returning to normal activities. Recovery can take several months, resulting in a lot of missed work days, which may add to worry and stress.

Doctors emphasize that depression related to heart attack is a serious illness and not simply feeling blue. It will not go away on its own. It is important to treat this depression because it increases the risk for another heart attack. Depression also is linked to abnormal heart rhythms, inflammation, increased blood pressure, high cholesterol levels, and faster blood clotting.

Depressed patients are 50% more likely than other heart attack patients to need hospital care for a heart problem within a year and are three times as likely to die from a future attack or other heart-related condition, according to a study by Johns Hopkins cardiologists. In a small 2008 study, major depression was an important predictor of cardiac complications, such as heart rhythm abnormalities, congestive heart failure, or a second heart attack, for patients who were still in the hospital. Another study indicates that for some individuals, an elevated risk of death lasts for at least 5 years after the heart attack.

When your husband asks his doctor about feeling depressed, the doctor may suggest psychotherapy, counseling, medication, or a combination of these therapies. Two recent sets of treatment guidelines for physicians reviewed available research and concluded that treatment with a type of antidepressants - selective serotonin reuptake inhibitors (SSRIs) - in combination with psychotherapy improves symptoms of depression. The SSRIs are safe in patients who have had a heart attack.

Your husband also might consider participating in an American Heart Association-affiliated support group called “The Mended Hearts,” which is comprised of heart attack survivors. Some individuals find that talking to other people who have experienced a heart attack helps them feel better.