By Mark Ketterer, PhD, as told to Hallie Levine
If you have heart failure, you probably focus on ways to get your condition under control, like eating a healthy diet and taking your medications. You may not pay attention to how you feel mentally or emotionally, but you should. Why? Research shows that as many as 1 in 5 people with heart failure have depression, and about half of them have significant symptoms.
It’s hard to tease out the exact reasons why. A number of heart failure medications can cause symptoms, such as fatigue, that mimic depression. People with heart failure may also have other, related conditions, such as sleep apnea, that can impact mood. If someone has trouble with thinking and memory, it’s harder for them to do things like eat right and exercise, which may also lead to feeling down.
But does the heart failure itself causes depression, or does depression make heart failure worse? Those are the million-dollar questions, and the truth is, there are no good answers. What we do know is that the combination of the two is not good. People who are depressed, anxious, or both who also have heart failure have a greater risk of dying.
Here’s what everyone with heart failure should know about their mood, when to seek help, and what to do about it.
Check All Your Medications
Every time I see a patient in my office, I review their medical status and history -- including all the drugs they are on. Some medicines, such as beta blockers, which lower blood pressure, can cause fatigue. Digoxin, a common heart failure treatment, can cause a tremor and loss of appetite that can seem like anxiety. Oftentimes, people don’t need to go off of these medicines entirely; we just need to adjust their dose. We can also screen a person for sleep apnea and mild cognitive impairment, both of which can affect mood.
Stay Active and Social
If you have always been active, it can be so discouraging and disappointing to get winded while you mow your lawn or not be able to walk more than half a mile without getting tired. Many people just give up and withdraw from activities and social contact entirely. But we know that those are such important buffers against depression. In fact, studies show that people with heart failure who have more social support have better outcomes, including fewer stays in the hospital.
Go to church, join a book club, or meet friends for coffee one morning a week. Anything that gets you out of your house and around others will help. Another option: mindfulness meditation. Heart attack survivors who did just 15 minutes of meditation a day via an app for 8 weeks reported better quality of life than a control group, according to a study presented earlier this year at the European Society of Cardiology. You can also join a support group: They give you the opportunity to talk to people who understand what you are going through, so you feel less alone.
Know the Warning Signs
It’s common for people to feel sad, angry, or just plain anxious after a diagnosis of heart failure. But you should seek help if symptoms:
- Last more than 2 weeks.
- Keep you from participating in treatments to help you manage heart failure, like cardiac rehabilitation.
- Interfere with your day-to-day routine, including social activities and work.
- Lead to thoughts of self-harm or suicide.
Your primary care physician is a good person to talk to first. They can screen you for depression. They can also work with you to set up self-care strategies that can help, like getting enough exercise and sleep, as well as stress management and other basic techniques.
Consider Talk Therapy
Research shows it can be very helpful for managing depression. A 2015 study of people with heart failure and severe depression found that those who did cognitive behavior therapy -- a type of therapy that examines the relationship between your thoughts and feelings and your behaviors -- reported less depression and anxiety, a better quality of life, and fewer heart-failure related hospitalizations than a control group.
If therapy doesn’t help, it’s very reasonable to consider a course of antidepressant medications. They help with mood, and there’s also some research to suggest that they may even help lower the risk of a heart attack in general.
Whether you feel depressed, anxious, or stressed, the most important thing is to seek help. Don’t just dismiss your feelings as a bad case of the blues. If you take actions to address your mental health, you may literally save your own life.