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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 (22.6%).

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.

Individual approach

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

Help prevent coronary artery disease with this heart health report
Click to enlarge

Beating Heart Disease

If you follow the news about heart disease closely, it’s easy to be overwhelmed or confused about what puts you at risk and how you can protect yourself. This report helps you identify the risk factors you can control, which range from medical conditions such as high blood pressure to lifestyle choices such as an unhealthy diet or lack of exercise. Read more

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