Volatile emotions like anger and hostility are bad for heart health. But studies have shown that some of the quieter emotions can be just as toxic and damaging.
"Study after study has shown that people who feel lonely, depressed, and isolated are many times more likely to get sick and die prematurely - not only of heart disease but from virtually all causes - than those who have a sense of connection, love and community," Dean Ornish, MD, tells WebMD.
Ornish, the founder, president, and director of the nonprofit Preventive Medicine Research Institute in Sausalito, Calif., and the author of Love and Survival, points out that today many people don't have an extended family they see regularly, or live in a neighborhood with two or three generations of neighbors. Many don't have a job that promises stability or go to a house of worship every week. "These things affect our survival to a much larger degree than people had once thought," he says.
Unfortunately, says Ornish, "many people think of these as things you do after you've done all the 'important' stuff," such as diet and exercise. What winds up happening is people often regard spending time with family and friends as a luxury. "What these studies show us is that this is the important stuff," Ornish says. "We are touchy, feely creatures, we're creatures of community, and we ignore these things at our own peril."
Raising awareness so that people who are lonely and depressed can face these problems is very important, says Ornish. "It's very hard to get people even to take their medication, if you don't address these issues. That's where awareness is the first step in healing. If a physician can spend more time with their patients talking about these issues, these people can begin to make different choices in their lives."
Depression and the Heart
"The general results of studies are that, for the most part, we believe depression is a risk factor for the development of heart disease," says Matthew Burg, PhD, associate clinical professor of medicine at Yale University School of Medicine and Columbia School of Medicine.
Burg points out that in people who have already suffered a heart attack that requires surgery to unclog blocked arteries, depression is also associated with poor outcomes, such as an earlier death or subsequent heart attack.
Social isolation and low levels of social support are similarly associated with increased risk for heart disease complications, he says.
Most cardiologists agree these results are important, says Burg. But while cardiologists know what to do about cholesterol and blood pressure, they often don't know what to do about depression and stress, or even how to get patients to reveal how they feel. "It's not like going to a patient and saying, 'You have high cholesterol, and here's the pill,'" says Burg.
Talking About Your Emotions
Not surprisingly, people have an easier time discussing their blood sugar and cholesterol than speaking about their psychological state. "People don't like being depressed but, in our society, there is a certain stigma about things like depression," Burg says. "When patients are not as forthcoming about these issues, it makes it that much harder to identify and treat."
"A person who has suffered a heart attack is likely to say things like, 'Of course I'm depressed, I just had a heart attack,'" Burg says. "But very often, when we take a closer look, what we find is the symptoms of depression predate the heart attack.
"The depression after a heart attack, which we would call an adjustment problem or adjustment disorder, actually dissipates within a matter of weeks. If the symptoms persist, we're really talking about a depression independent of the heart disease." These emotions, when prolonged, "are worth paying attention to, because of the potential effect they're having on the cardiovascular system."
It's Tougher on Women
In cases of depression, women outnumber men 2 to 1, says Nieca Goldberg, MD, chief of women's cardiac care, Lenox Hill Hospital, who runs a practice for heart disease in women. Goldberg points out that many women, adopting what's called the "tend and befriend" attitude, internalize their anger and disappointment instead of expressing these emotions, and become nicer and more nurturing. "You can be that quiet person that holds everything in and still have the increase in stress reactions."
Goldberg, who wrote Women Are Not Small Men: Life-saving Strategies for Preventing and Healing Heart Disease in Women, also cites a recent study in The New England Journal of Medicine conducted by researchers at Johns Hopkins. The researchers found that sudden emotional stress could result in severe weakness in the heart muscle, making it seem as though the person was having a heart attack. This "broken heart syndrome," says Goldberg, was more common in women.
"I think it's a common thing that women put themselves last on the list and feel very time-pressed to go to exercise or take down time for themselves," says Goldberg, who feels it's especially important to help women identify their support network.
Balancing the Emotions
"Any imbalance in an emotional state - when one emotion dominates or overrides the others - can predispose one to heart disease," says Frank Lipman, MD, an integrative physician, board-certified internist, and licensed acupuncturist. "Learning to deal with emotions is extremely important."
But studying these emotional states is difficult, concedes Lipman, the author of Total Renewal: 7 Key Steps to Resilience, Vitality and Long-Term Health. "It's not something you can measure easily." Nonetheless, emotions can get stuck in the body. When you release these emotional holding patterns physically, he says, you're releasing emotional states, as well.
Lipman has facilitated these releases in patients through acupuncture. He also refers some patients to body workers and healers, who are able to shift energy in the body.
How Doctors Can Help Eradicate Negative Emotions
Asking about the patient's emotional state should clearly be part of the medical history, even though doctor-patient time is often abbreviated, says Goldberg. Helping people make changes in their lives to improve health means recognizing the potential barriers that go beyond the person being able to afford their medicine and going to the gym.
Understanding patients' fears and anxieties is very important, she says. Sometimes, careful observation does the trick, such as noting whether anxiety is provoking patients to sit very forward in a chair or whether they look as though they're not taking care of themselves or putting on weight.
For the very stressed, Goldberg may refer patients to behavioral psychologists to help alter response to certain triggers. She also refers patients for psychological counseling. If medications seem necessary, she might refer a patient to a psychopharmacologist. Sometimes, she prescribes antidepressants.
For clinical psychologist Burg, it's about working with patients in a therapeutic situation to help them work their way through reactions that are prolonged. It's also about helping patients figure out new ways to deal with their life circumstances and put these in a new context. "In difficult circumstances, we don't always see the resources that otherwise might be available to us," he says.
"Depression is treatable, whether through medication, counseling, or both," says Ornish, who says patients appreciate when they sense their doctor cares about them by asking these questions. Ornish alerts patients to actions that are really part of all spiritual traditions - altruism, compassion, meditation. "What these traditions teach us is that these are things in our own self-interest," he says. "When you help someone else - when you forgive them, do service for them, love them - you heal your isolation. So it's really the most selfish thing you can do - to be unselfish that way."
Eradicating negative emotions connected with heart disease is best addressed through a true physician-patient partnership. "It's not enough to provide people with information and expect them to change," says Ornish. "We need to work at a deeper level."