The American Heart Association reports that while an estimated 10 percent of Americans ages 18 and older acknowledge depression, up to 33 percent of heart attack patients develop some degree of depression.
Dr. Michelle Riba, professor of psychiatry and associate chair for U-M’s Integrated Medical and Psychiatric Services in the Department of Psychiatry and associate director of the U-M Comprehensive Depression Center, takes it a step further: “It’s very complicated,” she says, noting that “almost every major cardiac condition has psychological issues that need to be addressed.” Monitoring a heart patient’s mental health is just as important as treating his or her physical condition, she says.
It gets even more complicated, says Dr. Riba, because not only can cardiovascular disease lead to depression, but also depression can lead to cardiovascular disease. “It’s bidirectional.”
According to research in the Journal of the American Heart Association, persistent depression may double the risk of stroke in adults over 50. What’s more, new research in Circulation: Cardiovascular Quality and Outcomes (American Heart Association journal) reports that the combination of stress and depression can significantly increase a heart patient’s risk of death or heart attack.
Treating the individual
“A patient who receives a heart disease diagnosis is likely to feel anxiety or depression, depending on the diagnosis and also the treatment,” says Dr. Riba, adding that different types of heart disease can lead to different types of depression or anxiety. “Each carries a unique psychiatric issue for individual patients. For example, a patient who faces the challenges of living with an implantable cardioverter defibrillator (ICD) may have anxiety about the device being activated and how that will feel.”
Other cardiac patients may no longer be able to do the things that were once part of their stress-reduction routine, such as running or other forms of exercise. So, not only are they unable to relieve their stress, they feel anxiety about it, says Dr. Riba.
Adding to the circumstances, “The drugs used to treat many heart-related diseases are also known to potentially exacerbate depression or anxiety in some patients,” she says. “We need to be aware of which medications are better in the treatment of heart disease. We look at the individual patient and determine what will work best for him or her in the way of medication and/or therapy.”
Ask for help
Most important, Dr. Riba stresses, “A patient should ask for help for their depression, anxiety or other psychological conditions. We hope that with more education and support, patients will feel comfortable discussing their emotional issues with their clinicians.”
Take the next step:
The U-M Department of Psychiatry and Depression Center offer a wide range of mental health care and perform research to improve care everywhere. From innovative clinics to novel outreach efforts, U-M psychiatrists, psychologists, social workers, neuroscientists and others use their expertise to aid patients of all ages. Both the center and department are based at the Rachel Upjohn Building on U-M’s East Medical Campus, with inpatient units and psychiatric emergency care in U-M hospitals and basic research at the Molecular and Behavioral Neuroscience Institute.
The University of Michigan Samuel and Jean Frankel Cardiovascular Center is a top ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org.