Most people have felt sad or lonely at times, especially in the winter months when the days are darker, shorter, and colder. But for women who are at risk or who have been diagnosed with cardiovascular disease, it’s important to take extra care to keep mental stress and depression at bay any time of year, because of the major impact it can have on heart health.

Studies have shown that mental health and physical health can have damaging effects on each other. Depression may lead to high blood pressure, arterial damage, irregular heart rhythms, and a weakened immune system. For women who already have heart disease, they may struggle with this reality and become depressed, which increases the risk of a heart attack or blood clots.

“A heart attack is a life-changing event,” said Nieca Goldberg, MD, a cardiologist and director of the New York University Women’s Heart Center in its Langone Medical Center in New York City. “Women feel very vulnerable and have concerns about being able to care for their family. They also have a tendency to feel isolated and concerned about having another heart attack.”

Dr. Goldberg said about 30% of her patients have dealt with depression along with heart disease. She recommends a combination of psychotherapy and medication for treatment when heart patients experience depression.

The Benefits of Psychotherapy for Treating Depression

Any negative health event can bring up fear and powerlessness,” said Jennifer Finlayson-Fife, PhD, a psychotherapist who practices in Winnetka, IL. “Feeling that you have little control over negative life events is a hallmark of depression. Women may be more likely than men to ruminate about their situation and potentially move into feelings of hopelessness and despair.”

Psychotherapy can help people recognize their negative, often distorted thought patterns that trigger and sustain depression, Dr. Finlayson-Fife said.

“Therapy provides an opportunity for a depressed client to recognize her capacity to act on her own behalf even in the face of disappointment,” she said. “Rather than resigning herself to be a powerless stance, she can learn to act on behalf of her own needs and desires. Recognizing and owning your ability to respond to all of life’s events and to shape the future is critical to feelings of life satisfaction and happiness.”

Physical Activity Critical to Keep Depression at Bay

“Some studies have suggested that 30 minutes of exercise each day has a similar effect on the brain as a low-level anti-depressant,” Dr. Finlayson-Fife said. “Even conscientious, deep, relaxed breathing has been shown to lessen depressive symptoms.”

A study sponsored by the National Heart, Lung, and Blood Institute found that treating depression after a heart attack may help a person feel better, but doesn’t lower the risk of a second heart attack or death. Researchers noted that earlier intervention with depression may make more of a difference, so treating heart disease patients who are depressed before they have a heart attack may have life-saving results.

Finding Support

Support groups for women dealing with heart disease, such as the NorthShore University Health System Women’s Heart Health center in Glenview, IL, can be found around the country. 

“Many women find it helpful to learn that someone else has similar issues in the recovery process,” said Jean Skelskey, RN, a cardiology nurse and coordinator for the program.

“I recently had a woman, age 48, who had a heart attack, tell me that when she told her story to some of her acquaintances, some of whom are physicians, they said, ‘But you look great!’ Skelskey recounted. “She wonders, ‘Just because I had a heart attack should I look bad? And just because I look great does not mean that I am not at risk.’” 

There are many women in their 50s and above who look physically fit on the outside, but who are fighting heart disease on the inside. But if they stay optimistic, they can cope with their heart problems in healthy ways.

On the other hand, many cases of depression go unrecognized and untreated, and depressed people are more likely to smoke, eat poorly, avoid exercise, and neglect their medications, which are risk factors that can contribute to heart disease.

Symptoms of Depression May Include:

• Feeling tired and weak
• Difficulty concentrating or making decisions
• Persistently feeling empty and sad, worthless, hopeless
• Apathy, lack of interest in usual activities
• Insomnia, early-morning waking, or excessive sleeping
• Unintentional weight gain from overeating or weight loss from appetite loss
• Crying spells for no apparent reason
• Loss of interest in pleasurable hobbies or activities, including sex
• Irritability, restlessness
• Poor hygiene or messy appearance
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems like back pain, headaches, digestive problems.

But, there are ways to fight depression—and help strengthen your body against heart disease as well:

• Manage your stress through yoga and meditation
• Write your feelings down in a journal
• Exercise on a regular basis
• Try to spend at least an hour each day doing something you enjoy
• Look for opportunities to serve others and reach out
• Seek friends who lift you up and avoid people who are pessimistic and negative
• Manage your anger and avoid things that trigger anger
• Avoid alcohol, which can make depression worse
• Plan outings that will bring joy, whether it’s going to a funny movie with friends or going for a walk and enjoying the outdoors
• Get enough sleep, eat healthy foods, and make yourself a priority
• Seek help through support groups, counseling, or medication as recommended by your physician.

–Sarah Severson

Resources:

• Cleveland Clinic: http://my.clevelandclinic.org/heart/prevention/stress/depressionandheart.aspx
• ENRICHD Heart Health Study: http://www.psychosomaticmedicine.org/cgi/content/full/63/5/747
• Dr. Jennifer Finlayson-Fife: http://www.finlayson-fife.com
• Dr. Nieca Goldberg: http://niecagoldbergmd.com/about-dr-goldberg
• National Institute of Health: http://www.nhlbi.nih.gov/new/press/01-11-13.htm
• National Institute of Mental Health – Women and Depression: http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/complete-index.shtml
• WomenHeart: The National Coalition for Women with Heart Disease: http://www.womenheart.org
• Women’s Heart Program of NorthShore University Health System’s Cardiovascular Care Center: http://www.northshore.org/clinicalservices/cardiology/treatment/whp/