What to Know About AFib and Your Mental Health

Medically Reviewed by James Beckerman, MD, FACC on June 28, 2022
6 min read

If you have atrial fibrillation (AFib), some research suggests you’re more likely to have depression and anxiety. But you might not know which came first. Your stress, anxiety, or depression may make you more likely to get AFib in the first place. But living with AFib can also make you more anxious and depressed.

One estimate says that about 4 in every 10 people with AFib also have depression, anxiety, or trouble with memory or thinking. For older people, studies show that number is higher, affecting 6 in 10.

Your struggles with mental health can make it harder to live with your heart condition. They can also make your AFib worse.

While it’s clear AFib often goes together with depression and anxiety, the reasons why aren’t certain. Researchers have looked at the connection to try to understand it better.

One study looked at people with AFib who were 65 and older to see if they had problems like depression, anxiety, cognitive impairment (trouble with thinking or memory), or poor quality of life. It found that 60% of them had at least one of those issues, and 25% had multiple conditions related to their mental health or their quality of life. Those who had more mental health-related symptoms also had more symptoms of the AFib.

Another study looked at many previous studies exploring the link between mental health and AFib. They looked at links between AFib and issues including:

  • Anxiety
  • Anger
  • Depression
  • Psychological stress

The result? They couldn’t find a link between any of these factors and your risk of having AFib. They say the evidence doesn’t all agree. Some studies suggest links, but others don’t.

This doesn’t mean there isn’t a connection, but the link may be complicated. For example, the researchers say depression might affect the timing of when your AFib starts. It also may affect how you’ll do with AFib or how severe your AFib symptoms are. They point to a study that looked at people with AFib who had depression, compared with those who had AFib without depression. It found that those with AFib and depression also had:

  • More risk of dying
  • More risk of stroke and brain hemorrhage
  • Worse quality of life related to their health problems

They said it wasn’t clear how depression or other mental health conditions might lead to AFib. Inflammation or changes in your nervous system could play a role. Even if the links aren’t clear, they suggest your AFib doctor should also check you for signs of depression or other mental health conditions. But treating your mental health issues won’t necessarily lower your risk of AFib.

Having any chronic health condition can be hard on your mental health. It’s possible the reason people with AFib often have more anxiety and depression is because living with AFib and its symptoms can be difficult. You may feel it keeps you from living life like you want.

One study found more mental distress and suicidal thoughts in those with AFib when compared to those who were considered healthy. Severe psychological distress, such as anxiety and depression, was found in 35% of those with symptomatic AFib. Of those, 20% had thoughts of suicide.

The kind of treatment you have for AFib may also make a difference in your mental health. Some people in the study had an ablation procedure, in which doctors damage your heart tissue to stop your abnormal heart rhythm. The rest took medicine instead. A year later, those who had the ablation were less likely to have anxiety or depression than those who took medications only. They also were less likely to still have suicidal thoughts.

It’s not clear why this happened. But researchers say it suggests having a procedure to correct AFib may be associated with improved mental health. It adds to the idea that AFib might cause depression and/or anxiety. Taking medicine every day to manage AFib and its related symptoms might not help with mental health as much. The study also suggests that you’re at more risk of mental health problems when you have AFib if you’re a more pessimistic or angry person.

Another study that looked at whether your mental health status affects how you do with AFib treatment. It found that poor mental health made it more likely your AFib would come back after an ablation procedure. So treatment that helps correct your abnormal heart rhythm might help with your mental health. At the same time, counseling or other help for your mental health issues might also make your AFib treatment more successful.

It’s possible, but more study is needed to be sure. One study looked at many other studies with data on this question. They focused on six that together included more than 2.5 million people. It found that, compared with people who don’t take antidepressants, people who take antidepressants more often have AFib. But that doesn’t mean antidepressants cause AFib.

The study didn’t find that same link between antidepressants and ventricular arrhythmias or sudden cardiac death. The reason antidepressants might cause AFib also aren’t known. So researchers say that more study is needed to sort out whether antidepressants really increase AFib risk.

More study also is needed to look at which antidepressants might raise your risk for AFib. A 2013 study looked at this in 38,000 people taking different antidepressants. It found that people taking bigger doses of three antidepressants, citalopram (Celexa), amitriptyline (Elavil), and escitalopram (Lexapro), showed slight changes on their electrocardiograms (ECGs) that are a risk factor for abnormal heart rhythms. But most people who have this never end up with AFib or another arrhythmia.

If you have AFib and you have signs of depression, ask your doctor if medicine can help you, and which ones are safe for you to take.

If you have a more severe mental illness, like schizophrenia or bipolar disorder, you’re not necessarily more likely to have AFib. But people with severe mental disorders often do have heart disease and other health problems related to their lifestyle and other factors. AFib is also the most common arrhythmia, so these two things can go together.

If you have both AFib and severe mental illness, you may find it harder to take medicines needed to lower your risks of other health problems, including a life-threatening stroke. Because of this, people with AFib and severe mental health conditions are more likely to have other related, and potentially serious, complications. Tell your doctor if you need help taking steps to lower your risk for a stroke or other serious health problems.

You can try various things to cope yourself and see if it helps. Everyone is different, but some ideas that might help you manage stress or anxiety include:

  • Exercise
  • Support from your friends and family
  • Time with your friends and family
  • Relaxation techniques
  • Meditation
  • Yoga
  • Eating well
  • Sleeping well

If you’ve tried these but you’re still struggling, ask your doctor or therapist for help. You may need treatment for depression if you’re:

  • Withdrawing from activities
  • Not able to enjoy family and friends
  • Having negative thoughts
  • Crying a lot
  • Struggling with everyday activities or work
  • Having thoughts of suicide

Everyone feels down sometimes. But if you’ve been feeling depressed for 2 weeks or more, reach out for help. If you have thoughts of suicide, tell your doctor, call a suicide hotline, or go to the emergency room right away.