Depression and heart disease: what’s the link?

Although heart health and mental health are often viewed as distinct, they are very much related. The tight connection between the mind and heart can be good news: If you take steps to protect one, you may well be protecting the other, too.

A two-way relationship

People with depression have an increased risk for developing heart disease. The reverse is also true: People with heart disease—such as those who’ve had a heart attack or have heart failure—have an increased risk for developing depression.

One reason the two conditions often occur together is that they are interwoven with an array of related risk factors. For example, having heart disease may cause someone to limit their activities, which in turn may up their risk of depression. Meanwhile, people who are depressed may be more likely to adopt unhealthy habits such as not exercising enough, drinking too much alcohol, smoking, overeating, and eating poorly—all of which increase one’s risk for heart disease.

Depression impacts the heart

Although it’s sometimes considered “mental” and apart from the body, depression has a physical basis and a host of physical effects, many of which relate to heart function. These effects include:

• Inflammation that can damage the lining of blood vessels, paving the way for arteriosclerosis (hardening of the arteries)
• Increased tendency of blood to clot, which can accelerate arteriosclerosis
• Nervous system changes that alter heart rate

These types of changes lead to a higher risk of heart attack and sudden cardiac arrest in patients with depression.

Meanwhile, experiencing a serious manifestation of heart disease, such as a heart attack, bumps up depression risk. Indeed, up to one in three people who have had a heart attack will have symptoms of depression.

The heart can influence depression

A heart attack survivor often has obvious reasons for feeling depression symptoms along with the physical responses. Such a profound event can change your perspective on life and cause unease about what comes next. Someone who has had a heart attack might look back with regret at behaviors they believe increased their risk. They might also see themselves differently and experience lost confidence or increased doubts about their ability to succeed at work or in personal relationships.

Although any of these feelings is natural following a life-threatening health event, they can snowball into something bigger—a mental health struggle that affects your ability to function in daily life. When that happens, getting the right intervention is crucial because depression can not only be dangerous in its own right, it may also interfere with recovery from the heart attack.

In addition to starting a cardiac rehabilitation program to help rebuild physical stamina, counseling and medication support can help ease the symptoms of depression and get you on the path to recovery for mind and heart.

Knowing when feelings of worry and loss cross over into depression can be tough, but one key is to assess for zest: Do you feel the same enthusiasm about things that you enjoyed before? If not, or if you detect other symptoms of low mood, an assessment for depression might be in order.

What about female bias?

Women who have experienced a heart attack or have other heart disease have a particularly high risk for depression. Young women—those under the age of 55—who have both depression and early signs of clogged arteries have a heightened risk for the worst outcomes from heart disease, including death, compared to their male counterparts and older women.

The stress effect

Depression isn’t the only mental health condition tied to heart disease. Emotional distress can also raise the odds of disease in the arteries that feed the heart. Although conventional wisdom has always linked stress and heart attacks, research more recently confirms that psychological stress increases risk for a heart attack or stroke. In fact, the greater the stress, the greater the risk.

What you can do: treatment

For people who already have heart disease and depression or anxiety, mental health treatment may help reduce the risk for heart-related death—and many cardiac rehab programs, in fact, include a mental health component. These treatments also reduce the mental health symptoms that people with heart disease experience, although exactly which combination of medication and non-drug therapy works best for each person remains to be established.

Generally, patients tend to benefit from some combination of medicines that boost mood along with counseling from a therapist who can help change thought patterns, address unhealthy behaviors, and suggest ways to relax.

Prevention strategies

But an ounce—or several—of prevention might help reduce the need for such treatment. Although you can’t control every factor that contributes to the risk for heart disease or depression, you can influence many of them. A healthy diet can help keep mind and heart in shape, as can regular exercise and avoiding smoking or drinking too much alcohol.

Because stress can contribute to heart disease and stroke risk, learning ways to relieve mental burdens can also be important.

There are many ways to relieve stress, and your choice will come down to what genuinely works for you. In addition to the recommended lifestyle adjustments that boost mind and heart health alike, some helpful stress-busters include deep-breathing exercises, meditation or mindfulness practices, and working with a counselor to remove causes of stress where possible.