Heart Health

07 January 2009

Depression can break your heart

Depression can be dangerous to someone who has had a heart attack and untreated depression can increase the risk of another attack, writes Prof Piet Oosthuizen.


Depression can be dangerous to someone who has had a heart attack and untreated depression can increase the risk of another attack, according to Professor Piet Oosthuizen's latest book, Ontsnap van Depressie*, from which the following extract is taken:

Why did our forefathers decide to refer to someone who is unhappy as suffering from "heartache"? And when someone has suffered a great loss we say that person's "heart is broken"...

Since ancient times the brain has been regarded as the seat of the intellect and the heart as the seat of the emotions. This was probably deduced from the fact that our hearts beat more quickly when we're excited or upset.

I'm not sure about all the facts but it does seem as if people, long ago, knew something we're only now rediscovering; that there's a clear connection between one's heart and one's state of mind and, more specifically, between troubled emotions and heart disease.

Most people are unaware of the fact but as many as a quarter of all patients who suffer from ischemic heart disease (narrowed coronary arteries) suffer from depression.

This means people in this group are twice as likely to develop depression as the rest of the population. The opposite is also true: people who suffer from depression have a greater chance of having a heart attack.

Depression can therefore "break your heart". The problem is that people who have heart disease are not often diagnosed as suffering from depression; this is because the connection between the two conditions is not generally known.

Although heart patients are usually asked about their lifestyle and exercise, eating and smoking habits, an evaluation of the person's state of mind is not part of the routine.

I have always quietly admired the unbelievable support women who have breast cancer give to each other. If a woman is diagnosed with breast cancer it's not long before a member of a support group arrives to offer help.

This is sustained right through the rehabilitation process and once she has recovered she, in turn, becomes involved in supporting other women in the same situation. What a wonderful example of human compassion!

Unfortunately, heart disease has not yet reached the same level. Often patients are treated quite unsympathetically and left to cope on their own.

Frik van Zyl experienced this first-hand. He is middle-aged, spends the entire day behind a desk and has steadily been gaining weight over the past few years. His wife became worried and insisted that he start exercising. Frik grudgingly agreed to go to a gym and engaged the services of a personal trainer to assist and motivate him.

Soon Frik found that he actually enjoyed cycling and started pushing himself harder. His instructor allowed him to gradually increase his level of intensity.

One day, while sitting on the exercise cycle, he suddenly felt very tired. It felt as if someone was sitting on his chest and he was short of breath.

His instructor stopped the session immediately and ordered Frik to go and see his doctor. His GP couldn't find anything wrong but sent him to a cardiologist - just to play it safe. There he was connected to an ECG machine and asked to climb up and down a set of stairs.

It wasn't long before the concerned cardiologist informed the poor man that apparently some of the arteries leading to his heart were blocked and that he would have to be admitted to a hospital for an angiogram.

Less than 48 hours later Frik underwent a triple heart bypass - his chest was opened up and arteries were removed from his legs and transplanted into his heart. Because he's still relatively young and has no other physical problems he recovered extremely well. He was discharged after a few days and was scheduled to see the doctor in a few weeks' time. It was truly one of the miracles of modern medicine.

The problem was that Frik actually ended up feeling worse after the operation than before. He couldn't sleep, often felt short of breath and experienced pressure on his chest.

He was convinced he was going to have a heart attack and die. Several trips to the emergency unit of the hospital and an early visit to the cardiologist yielded nothing and he was reassured. His heart was working properly and there was no sign of ischemia (not enough oxygen to the heart).

The reassurance didn't help. Frik slept even worse than before; he became grumpy and couldn't eat properly.

He refused to go out because he was scared he might have a heart attack in a public place - far from medical facilities - and die. The cardiologist assured him he was fine and that it was "only his imagination". But Frik's state of mind continued to deteriorate. Finally his wife couldn't take it any longer.

She came to see me so I could help her cope with her husband's personality change since his heart operation. I asked her to bring him to the next session and even though he initially dug in his heels she persuaded him to come along.

During the interview Frik had a panic attack. It wasn't difficult to see he was feeling very depressed and despondent. Fortunately I managed to assure him his problem was treatable.

A combination of antidepressant medication and psychotherapy gradually lifted him out of his depression. The panic attacks became less frequent and severe and finally stopped altogether. Frik could return to his normal life but only after suffering intense physical and emotional trauma. At the time of his final session with me he was entirely healthy and physically normal.

He agreed to carry on with his medication for the full 12 months and to come and see me if he wanted to stop. There is currently incontrovertible proof that depression has a very bad effect on someone who has suffered a heart attack. There are a number of possible reasons for this: people who are feeling depressed don't take very good care of themselves, they tend to exercise less, they smoke more, etc.

This is however not sufficient explanation for the connection between these two conditions. The strongest theory is that there is a common biological factor which causes both depression and heart disease. If someone has already had a heart attack the team responsible for his treatment should make sure he undergoes proper rehabilitation.

One of the most important steps to prevent a second heart attack is to stop smoking. Nowadays all doctors are aware of this and will apply a lot of pressure on their patients to kick the smoking habit.

Unfortunately there aren't as many doctors who realise that untreated depression holds just as big a risk for a second heart attack. After a heart attack patients should receive counseling about the effect it may have on their state of mind so treatment can be made available in time if necessary.

Recent studies indicate that people who suffer from depression recover more quickly and live longer after a heart attack if they take sertraline (a well-known antidepressant).

The purpose of this story is to remind us once again depression is a disease of the brain, the brain is part of the body and there is a close interaction between the brain and the rest of the body.

Medical and psychiatric diseases are often so interwoven it would be senseless to try separate them entirely.

[This story originally appeared in YOU Pulse. Buy the latest copy, on newsstand now, for more fascinating stories in the world of health and wellness.]

* To order a copy of Ontsnap van Depressie, by Piet Oosthuizen, click here

YOU Pulse; Spring, September 2007


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