Harvard Mental Health Letter

Mind and mood after a heart attack

Could psychiatric treatment save the lives of heart patients?

A sad or broken heart can have more than one meaning. What research physicians call a cardiovascular event — including heart attacks, strokes, cardiac arrest, angina (severe chest pain), surgery involving the coronary arteries, and other cardiovascular problems — is also an event in consciousness, with emotional consequences. Heart disease can be depressing, anxiety-provoking, and traumatic. About 50% of patients hospitalized with coronary artery disease have some depressive symptoms, and up to 20% develop major depression. Depression may be even more common in survivors of strokes. In addition, a review of 25 studies found that 15% of patients developed post-traumatic stress disorder after a heart attack, sudden cardiac arrest, or cardiac surgery.

Depression and anxiety in heart disease patients raise the risk of deterioration and death. People hospitalized or undergoing surgery for heart conditions are 2–5 times more likely than average to die or suffer further cardiovascular events in the following year if they have symptoms of depression at the time of hospitalization. Depression has a similar effect on patients hospitalized for heart failure (inability of the heart to pump sufficient blood). In fact, recurrence of cardiovascular events is more closely linked to depression than to high cholesterol, smoking, high blood pressure, or diabetes.

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