Does a heart attack trigger depression? Does depression trigger a heart attack? No one is sure.
A heart attack is a catastrophic event, and a typical reaction includes periods of denial or despair, along with a mixture of symptoms of despondency, anxiety, insomnia, and irritability. For the majority of heart attack patients, these symptoms last a few days to several weeks after diagnosis, but then adjustment ensues as they learn -- with the help of family, friends, and doctors -- to cope with the recovery process.
But in many cases, depression is more persistent. These are the heart attack patients whose depression may eventually trigger a fatal cardiac arrest within one year. It’s too often the case that doctors, even many cardiac specialists, view depression in a patient recovering from a heart attack as "normal.” Granted, sadness and grief are normal reactions to loss, but a major depressive syndrome requires aggressive treatment. Clinical depression is not a normal consequence of a heart attack and it must be addressed and treated promptly -- just as the heart attack itself was treated.
Johns Hopkins cardiologist David E. Bush, M.D. has extensively studied depression in heart attack patients. Here he answers patients’ questions about this often-misunderstood condition.
Q. How prevalent is depression in people who have suffered a heart attack?
A. According to research reported in the Journal of Psychosomatic Medicine by researchers from the University Hospital Groningen in the Netherlands, about 18 percent of heart attack survivors have major depression following their heart attack. Depressed heart attack patients were found to be more than twice as likely to die from any cause and 2.5 times as likely to die of heart disease when compared with heart attack patients without depression.
Q. What is the risk of dying due to depression following a heart attack?
A. Depressed patients are 50 percent more likely than other heart attack patients to need hospital care. The mortality of those who are depressed while recovering from a heart attack compared to those who are not depressed in the same circumstances is two to four times higher. There seems to be a substantial increase in mortality that becomes apparent in the first four to six months of recovery from a heart attack.
Q. Are patients who are currently suffering from depression at risk for suffering a heart attack?
A. Heart disease and depression are intricately entwined and there is mounting evidence that an ill mind may be the cause of an ill heart. One Johns Hopkins study followed 1,200 male Johns Hopkins medical school graduates for 40 years, testing them every five years. Overall, there was a 12 percent incidence of depression. Among those who were depressed, there was twice as great a risk of developing coronary artery disease or having a heart attack compared to those subjects who were not depressed.
More evidence for this comes from the Women's Health Initiative, a major 15-year research program that addressed the most common causes of death, disability, and poor quality of life in postmenopausal women (cardiovascular disease, cancer, and osteoporosis). Researchers reported that among the 93,000 women studied, those who were depressed had a 50 percent greater risk of developing or dying from cardiovascular disease than women who didn’t show signs of depression.
