Don't neglect your feelings after a heart attack

Are you feeling sad or anxious after a heart attack or other heart problem? You're not alone. In multiple studies, anxiety, stress and depression are identified in about one out of every five patients who have experienced a significant heart event, such as a heart attack or cardiac arrest.

"It's fairly common and there are a lot of emotions that people feel because they wonder if it's going to happen again or they are feeling more mortal than before the heart attack," John T. Lake, MD, a clinical psychiatrist with Southeast Behavioral Health said.

In the United States, an estimated 92 million Americans are living with some form of cardiovascular disease or the after effects of a stroke. What researchers have found is that depression is a major risk factor for a poorer recovery and long-term outcome. In fact, the American College of Cardiology notes that heart patients have a five times increased risk of dying if depression is not treated.

"It's been well-documented that depression is a major risk factor for dying within six months after a heart incident," says board certified cardiologist David Law, MD, with Cardiovascular Consultants in Cape Girardeau said. "What many people don't realize is that over the long term, even minor depression is associated with an increase in mortality."

Clinical depression is more than feeling sad or anxious for short periods of time. Depression is a major behavior health disorder that is recognized as a serious medical illness that, if left untreated, can lead to further medical problems. Symptoms can range from mild to severe and last for two weeks or longer.

Cardiologists in Cape Girardeau often refer patients to Dr. Lake, who moved from leading inpatient psychiatric services at Southeast Hospital to providing outpatient services last year. He's the only psychiatrist outside of local mental health agencies who offers outpatient psychiatric services in Cape Girardeau.

"I'd like residents to realize that psychiatrists are the primary care physicians of the brain," he said. "We use evidence-based therapy to identify the right therapies for each patient. And the reality is that your heart is not fully going to recover unless the brain also is healthy."

Dr. Lake presented information about the importance of being aware of post-cardiac depression at a SoutheastHEALTH cardiovascular conference last year. He shared a dramatic image of a PET scan of the brain showing brain activity during periods of depression and normal brain activity.

"You can really see that in a depressed individual, brain activity is far less," Dr. Lake said. "The critical point to make, too, is that the longer a person has depression, the harder it is to treat."

The good news is that there are many effective medical strategies for dealing with depression. Treatment options can include education and stress reduction techniques, cognitive behavioral therapy and medications.

"There are many newer medications that we can use that are not habit-forming and can effectively treat depression," Dr. Lake said. "We also work closely with the cardiologists involved in the patient's care because patients often have to take multiple medications for their heart condition."

Typically, Dr. Lake notes, patients will experience a remission of their depression in about four weeks, although medications are typically prescribed for up to nine months. "It's not lifelong treatment in the majority of these cases," he said.

The take-away message for heart patients? Dr. Lake said, "If you are stressed for a long time, or feeling blue or anxious, let us determine if we can help manage that stress or if you need to be treated for depression. Some people don't take depression seriously. For their heart health, they should."