Different shades of gray for post-heart attack depression
Recovering from a heart attack is tough enough without facing the fog
of depression. Yet that’s exactly what happens to nearly half of
heart attack survivors. People with post-heart attack depression are
two to three times more likely to have another heart attack or to die
prematurely compared with survivors who don’t have depression.
Depression after a heart attack isn’t a one-size-fits-all classification.
The severity of depression varies from person to person, as does the
effect of depression on the heart and recovery. Developing depression
for the very first time during recovery from a heart attack appears to
be more cardiotoxic than depression that started before the attack.
Dutch researchers found that among the volunteers who developed depression
for the very first time after their heart attacks, 33% died of cardiovascular
disease or had a heart attack, stroke, or other cardiovascular event
during this time. That was far higher than among those who didn’t
develop depression (21.5%) or who were depressed before their attacks
What’s the difference?
Depression that first appears after a heart attack could be different
from classic depression. It may represent fear of dying, grief over the
loss of health, or trouble adjusting to the traumatic and life-changing
experience of a heart attack. Fear, grief, and post-traumatic stress
look a lot like depression but don’t necessarily respond to the
same treatment strategies.
Do antidepressants help heart attack survivors?
So far, clinical trials testing the safety and effectiveness of antidepressants
for heart attack survivors have included too few people and too little
time to paint an accurate picture of the safety and effectiveness of
these drugs. That said, the repercussions of depression are serious enough
to warrant antidepressant therapy if needed.
From a health perspective, depression gets in the way of taking medications
that protect the heart and blood vessels. It drains the resolve to exercise
or adopt a more healthful diet. It generates feelings of helplessness
and isolates people from those who can help.
Breaking out of depression can be tough to do on your own. It often
takes the efforts of a family member, friend, or doctor to help you recognize
the problem and tackle it.
The standard approach to depression includes talk therapy and medication.
Selective serotonin reuptake inhibitors such as citalopram (generic,
Celexa, Lexapro) or sertraline (generic, Zoloft) may help both depression
and heart disease.
Depression that first appears after a heart attack may respond to these
approaches as well. If not, ask your doctor for a referral to a therapist
who can help you sort out your thoughts and feelings and possibly hit
on a more specific therapy that can help you ease out from under depression.
Some physicians look on depression that appears after a heart attack
as an understandable reaction to a stressful event that will go away
as you get better. It is usually much more than that. Regardless of its
origin, recognizing the signs of depression, realizing they aren’t
just in your mind, and getting help will be good for your heart, your
health, and your life.
May 2007 update
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