Heart problems can cause a lot of physical challenges, but for many people, that’s only part of the story. A diagnosis of heart failure can also take a toll on your mental well-being.
If you have heart failure, you’re more likely to have mental health challenges such as anxiety and depression. The reverse is also true: Mental health conditions can put you at risk for heart problems.
It’s important to seek treatment for anxiety or depression, especially if you have heart failure. Left unmanaged, mental health challenges can make your condition worse and even raise your risk for a future cardiac event such as a heart attack.
What’s the Link Between Heart Failure, Anxiety, and Depression?
Researchers aren’t sure what the connection is between heart failure, anxiety, and depression. But they believe it works both ways: Heart problems make it more likely you’ll feel more anxious or depressed, and anxiety and depression raise your chances of heart trouble.
One possible reason why issues with mental health can plague people with heart conditions: A diagnosis of heart failure may cause feelings of extreme sadness, stress, or worry. These so-called natural emotional responses can persist and become severe. Over time, they can put a strain on your mental – and physical – health.
Some studies have also shown that heart failure has a link to an increased risk of suicide. This association is particularly strong during the first 6 months after a heart failure diagnosis.
On the flip side, having depression or anxiety raises your risk of heart failure. One analysis looked at 28 studies and found that people with depression had a 46% greater chance of heart disease, compared to healthy people.
Some research suggests that increased inflammation, which is one of the body’s responses to anxiety or depression, may be a trigger for heart issues.
Stress caused by anxiety and depression can:
- Put a strain on your heart rate
- Cause your blood pressure to rise
- Lessen blood flow to your heart
- Prompt your body to produce more cortisol (a stress hormone)
After a while, these effects can lead to heart problems.
There’s also some evidence that people with anxiety and depression may adopt unhealthy behaviors, such as smoking, inactivity, or heavy drinking. These habits can all increase the risk of heart issues.
And some of the medicines that people with depression or anxiety take may raise their risk of:
- Insulin resistance
- Heart attack
Can Anxiety and Depression Worsen Outcomes in People with Heart Failure?
Research shows that depression can worsen the prognosis for people with heart failure. But the connection between anxiety and heart outcomes seems to be less certain.
When people have both heart failure and depression, they tend to have more heart events and be admitted to the hospital more often. They also have a higher death rate. One analysis of eight studies revealed that people with heart failure who also had depression had twice the risk of death or a heart event as those who didn’t. Another study found that among people with heart disease, depression was the strongest predictor of death during the first 10 years after diagnosis.
Researchers haven’t studied the link between anxiety and heart failure outcomes as much, so the data isn’t as clear-cut. Some findings have suggested there’s no link between anxiety and the risk of death in people with heart failure. But one study found that having a specific type of anxiety disorder, called posttraumatic stress disorder (PTSD), increased a person’s chances of having a heart failure event by 47% over 7 years.
People with untreated depression or anxiety may also be less likely to take their heart medications as prescribed, which could lead to worse outcomes.
When to Talk to Your Doctor
It’s a good idea to talk to your doctor if you have heart failure and notice changes in mood that don’t go away. Or you may want to see a medical professional if you just don’t feel like your normal self.
While everyone is different, some symptoms of depression to watch out for include:
- Feeling sad or anxious
- Not taking part in activities you once enjoyed
- Isolating yourself from family and friends
- Thoughts of guilt, worthlessness, or hopelessness
- Crying often
- Memory or concentration problems
- Restlessness or crankiness
- Sleeping too much or too little
- Low energy
- Thoughts of suicide or attempting suicide
Some possible signs of anxiety are:
- Feeling nervous, tense, or restless
- Having feelings of panic or doom
- A fast heart rate
- Rapid and heavy breathing
- Trembling or shaking
- Feeling tired or weak
- Trouble sleeping
- Problems with concentrating
Strategies for Treating Anxiety and Depression Alongside Heart Failure
If you have heart failure, you have two main options to ease symptoms of depression or anxiety.
Psychotherapy. This is sometimes a preferred treatment for people with heart failure. That’s because it can help you learn long-term strategies to manage your symptoms. Also, it doesn’t pose any known side effects. Cognitive behavioral therapy (CBT), or “talk therapy,” is a type of psychotherapy that’s shown benefits in people with heart failure.
Antidepressants. A class of drugs called selective serotonin reuptake inhibitors (SSRIs) are also frequently used to treat depression and anxiety in people with heart failure.
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
These meds are generally considered safe, but they can interact with certain heart failure medicines, such as warfarin, antiarrhythmics, or angiotensin receptor blockers. They also may cause side effects, such as:
- An increased risk of bleeding, especially in people who take antiplatelet or anticoagulant drugs
- QT prolongation (a condition that raises the risk for potentially fatal heart arrhythmias)
While other classes of antidepressants can be used, they may not be safe for people with heart failure. Talk to your doctor about the benefits and risks of different medication options.
Tips for Lowering Stress
Lowering your stress levels may help to ease at least some of your symptoms of anxiety or depression. To make your lifestyle healthier for both your outlook and your heart, try to:
- Eat a healthy diet: Stay away from sugar, sodium, unhealthy fats, and high-calorie foods, and include more fruits, veggies, and whole grains in your diet.
- Exercise: Just walking for 30 minutes a day can boost your mood and improve your quality of life.
- Use relaxation techniques: Yoga, meditation, or tai chi can help you relax and manage your symptoms.
- Get quality sleep: Go to bed and wake up at the same time every day, and keep daytime naps short.
- Steer clear of caffeine, nicotine, and alcohol: These substances can worsen symptoms of anxiety and depression.
Cleveland Clinic: “Heart Failure: Emotional Aspects.”
Current Psychiatry Reports: “Anxiety disorders and cardiovascular disease.”
European Journal of Heart Failure: “Depression and heart failure: the lonely comorbidity.”
CDC: “Heart Disease and Mental Health Disorders.”
National Institutes of Health: “Heart disease and depression: A two-way relationship.”
American Heart Association: “How Does Depression Affect the Heart?”
Harvard Review of Psychiatry: “Depression and Anxiety in Heart Failure: a Review.”
Johns Hopkins Medicine: “Anxiety and Heart Disease.”
Current Cardiology Reports: “The Role of Depression on Treatment Adherence in Patients with Heart Failure – a Systematic Review of the Literature.”
Mayo Clinic: “Anxiety disorders,” “11 tips for coping with an anxiety disorder.”
ARYA Atherosclerosis: “Antidepressants and cardiovascular adverse events: A narrative review.”
Harvard Health Publishing: “Tips for beating anxiety to get a better night’s sleep.”
BMC Medicine: “So depression is an inflammatory disease, but where does the inflammation come from?”
Journal of the American College of Cardiology: “Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes.”