Depression can affect the heart in many ways, both before and after heart disease. It can disrupt the heart’s rhythm, encourage inflammation and blood clots, and bathe the body in stress hormones that can raise blood pressure and harden arteries.
People with blocked coronary arteries have reduced blood flow to the heart, but they can also have blockage in the arteries in their brain making them vulnerable to strokes.
Strokes can affect mood and trigger depression, says Peter Shapiro, MD, Associate Professor of Clinical Psychiatry at Columbia University in New York City. Small areas of brain damage caused by cerebrovascular disease are also associated with an increased risk of depression.
Depression leads to cardiac risk.
Depressed people are more likely to have other risk factors that can contribute to heart disease. They are more prone to smoke, less likely to pay attention to diet and exercise, and more likely to neglect their prescribed medications—all serious risk factors for heart disease. Those who suffer from both heart disease and depression say their depressed mood affects their will to recover.
“Every heart patient is a potential depression patient.”
“You feel that your life has changed dramatically—your own mortality is slapped in your face,” says Bill Valvo, 60, of Newport News, Va., who suffers from heart disease and has had bypass surgery. “And then depression sets in. It’s like a well. It gets darker and deeper and if you don’t get help, you’re not getting out.”
He credits the support of his family, exercise, socializing, and volunteer work with helping him overcome depression and heart disease. Eight years later he worries more about his depression than his heart. “Sure, I could exercise more and eat better, and if I have another problem with heart disease I’ll treat it, but this depression stuff—I never lost it, I just pushed it back,” says Valvo.
“We need to look at every heart patient as a potential depression patient down the road,” says Leo Pozuelo, MD, Associate Director of the Bakken Heart-Brain Institute at the Cleveland Clinic.
Doctors don’t understand all the links between depression and heart disease, and patients usually have more than one risk factor. But one thing is clear: If you’re depressed and you have heart disease, you have to treat both conditions to recover.