What kinds of treatment are available for depression and anxiety?
Treatments for depression and anxiety include several different forms of therapy from a variety of counselors. Antidepressant medication may be helpful if therapy does not work for you.
Does psychological counseling help heart patients?
Psychological counseling is a broad term that can include talk therapy, stress management, relaxation exercises, coping techniques, and, in some cases, the use of antidepressant medications. Psychological counseling may be included in a cardiac rehabilitation program or performed independently. Studies show that heart patients who undergo either type of psychological counseling have lower levels of depression and anxiety and a better quality of life.26, 27
Does psychological counseling as part of cardiac rehabilitation reduce the risk of dying?
Heart patients who underwent psychological counseling as part of cardiac rehabilitation programs have greater reductions in psychological distress, blood pressure, heart rate, and cholesterol levels than people who underwent cardiac rehabilitation without a counseling component.28 Some, but not all studies 29, 30 found that people who participated in cardiac rehabilitation with psychological counseling were less likely to die or experience future heart problems.28 This reduced risk of heart problems and death was not always seen in women and elderly patients.31
Does independent psychological counseling reduce the risk of dying?
Counseling done outside of a cardiac rehabilitation program does not appear to provide the same benefits. In the largest study of psychological treatments, people treated with cognitive therapy (a more active form of therapy aimed at changing the way you think and associate behaviors) and/or antidepressants after a heart attack were just as likely to die or have another heart attack as people who did not receive psychological treatments.32 When the results were broken down by race and gender, psychological treatment slightly reduced the risk of heart attack and death in white men, but not in white women or minority men and women.
In studies of psychological counseling done outside of a cardiac rehabilitation program, women don't seem to derive as much benefit as men do, possibly because the treatments are less likely to work in women. Two studies of heart patients found that women were less likely than men to see improvements in depression and anxiety after a counseling intervention.33, 34 Montreal researchers found that the risk of dying from any cause was slightly higher for women who received counseling compared with those who did not.34 If the psychological treatment does not reduce your depression and anxiety, it is unlikely to reduce your risk of dying or having another heart attack. The Montreal study found that men and women who experienced reduced depression and anxiety after psychological counseling (i.e., the treatment worked) were less likely to die or be hospitalized for a heart-related cause than men and women in whom the treatment failed.
How important is emotional support from family and friends?
Social ties and emotional support from friends and family are important during the recovery process. Social ties can include a spouse, close family members, and friends, as well as participation in group activities (social gatherings, religious organizations, etc.). Socially isolated heart attack survivors are four times more likely to die than survivors with social ties.35 Heart problems, such as chest pain ( angina) or another heart attack, also occur more often in isolated individuals.35, 36 Emotional support from friends and family helps prevent depression, which in turn can reduce your risk of dying.9, 10 It's important to discuss your fears and concerns with your family members because people who suppress their feelings tend to do worse over time.
How can I cope with the reactions of my friends and family to my illness?
It's very common for your family and friends to experience anxiety, depression, and fear after you have a heart attack or heart procedure.37 Studies of people who had a heart attack, angioplasty, or bypass surgery found higher levels of anxiety and depression in the spouses than the patients.38-40 After a heart attack or heart procedure, you may feel that you are getting well, but close friends and relatives may be troubled by what has happened to you. Your spouse may feel that they're not getting enough support from healthcare providers,41-43 which can be both upsetting and frustrating. It's possible that your spouse's stress could delay your recovery.44, 45
Sometimes the reaction of your friends, children, or significant other may manifest as denial of the severity of your illness or even anger. This negative reaction may be a coping mechanism used to deal with feelings of fear. Your family members and friends may be afraid that you'll have another heart attack, or die. It may ease their fears to know that there are steps you can take to reduce your risk of future heart problems, such as taking your medicine as prescribed, eating healthier foods, and getting more exercise.
They may also be reassured to know that there are things they can do to help you in the event of a heart attack. Encourage them to become informed about heart disease. They should be familiar with heart attack symptoms and what to do if you experience them. It may also be helpful if they learned cardiopulmonary resuscitation, or CPR. Courses are usually offered at local hospitals, fire and rescue departments, or Red Cross chapters.
Click Here to Find Your Local Red Cross Chapter
How can I join a support group?
If you had a heart attack or have been diagnosed with heart disease, you may wish to join a support group of other women with heart disease to meet people who understand your specific fears, sadness, and worries. To find a support group, check with your local hospitals. WomenHeart, the National Coalition for Women with Heart Disease, runs free support networks with many locations all across the country. You can also try The Mended Hearts, Inc., which you can join for a small fee.
For more information:
WomenHeart Support Networks
Mended Hearts
References
1. Milani RV, Lavie CJ. Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease. Am J Cardiol. 1998;81:1233-1236.
2. Enhancing Recovery in Coronary Heart Disease (ENRICHD) study intervention: rationale and design. Psychosom Med. 2001;63:747-755.
3. McCrone S, Lenz E, Tarzian A, Perkins S. Anxiety and depression: incidence and patterns in patients after coronary artery bypass graft surgery. Appl Nurs Res. 2001;14:155-164.
4. Con AH, Linden W, Thompson JM, Ignaszewski A. The psychology of men and women recovering from coronary artery bypass surgery. J Cardiopulm Rehabil. 1999;19:152-161.
5. Watkins LL, Schneiderman N, Blumenthal JA, et al. Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction. Am Heart J. 2003;146:48-54.
6. Anxiety Disorders. Bethesda, MD: National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services; 2002 Reprint. NIH Publication No. 02-3879.
7. Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosom Med. 2001;63:221-230.
8. Mayou RA, Gill D, Thompson DR, et al. Depression and anxiety as predictors of outcome after myocardial infarction. Psychosom Med. 2000;62:212-219.
9. Welin C, Lappas G, Wilhelmsen L. Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med. 2000;247:629-639.
10. Frasure-Smith N, Lesperance F, Gravel G, et al. Social support, depression, and mortality during the first year after myocardial infarction. Circulation. 2000;101:1919-1924.
11. Bush DE, Ziegelstein RC, Tayback M, et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol. 2001;88:337-341.
12. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation. 1996;93:1976-1980.
13. Irvine J, Basinski A, Baker B, et al. Depression and risk of sudden cardiac death after acute myocardial infarction: testing for the confounding effects of fatigue. Psychosom Med. 1999;61:729-737.
14. Ladwig KH, Lehmacher W, Roth R, Breithardt G, Budde T, Borggrefe M. Factors which provoke post-infarction depression: results from the post-infarction late potential study (PILP). J Psychosom Res. 1992;36:723-729.
15. Frasure-Smith N, Lesperance F, Juneau M, Talajic M, Bourassa MG. Gender, Depression, and One-Year Prognosis After Myocardial Infarction. Psychosom Med. 1999;61:26-37.
16. Mallik S, Krumholz HM, Lin ZQ, et al. Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery. Circulation. 2005;111:271-277.
17. Grace SL, Abbey SE, Irvine J, Shnek ZM, Stewart DE. Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events. Psychother Psychosom. 2004;73:344-352.
18. An K, De Jong MJ, Riegel BJ, et al. A cross-sectional examination of changes in anxiety early after acute myocardial infarction. Heart Lung. 2004;33:75-82.
19. Moser DK, Dracup K, McKinley S, et al. An international perspective on gender differences in anxiety early after acute myocardial infarction. Psychosom Med. 2003;65:511-516.
20. Garvin BJ, Moser DK, Riegel B, McKinley S, Doering L, An K. Effects of gender and preference for information and control on anxiety early after myocardial infarction. Nurs Res. 2003;52:386-392.
21. Phillips Bute B, Mathew J, Blumenthal JA, et al. Female Gender Is Associated With Impaired Quality of Life 1 Year After Coronary Artery Bypass Surgery. Psychosom Med. 2003;65:944-951.
22. Lindquist R, Dupuis G, Terrin ML, et al. Comparison of health-related quality-of-life outcomes of men and women after coronary artery bypass surgery through 1 year: findings from the POST CABG Biobehavioral Study. Am Heart J. 2003;146:1038-1044.
23. O'Brien JL, Moser DK, Riegel B, Frazier SK, Garvin BJ, Kim KA. Comparison of anxiety assessments between clinicians and patients with acute myocardial infarction in cardiac critical care units. Am J Crit Care. 2001;10:97-103.
24. Frazier SK, Moser DK, O'Brien JL, Garvin BJ, An K, Macko M. Management of anxiety after acute myocardial infarction. Heart Lung. 2002;31:411-420.
25. Moser DK, Dracup K. Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events? Psychosom Med. 1996;58:395-401.
26. Swenson JR, O'Connor CM, Barton D, et al. Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome. Am J Cardiol. 2003;92:1271-1276.
27. Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women. Am J Cardiol. 1995;75:340-343.
28. Linden W, Stossel C, Maurice J. Psychosocial interventions for patients with coronary artery disease: a meta-analysis. Arch Intern Med. 1996;156:745-752.
29. Rees K, Bennett P, West R, Davey SG, Ebrahim S. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2004:CD002902.
30. Jones DA, West RR. Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial. Bmj. 1996;313:1517-1521.
31. Linden W. Psychological treatments in cardiac rehabilitation: review of rationales and outcomes. J Psychosom Res. 2000;48:443-454.
32. Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Jama. 2003;289:3106-3116.
33. Cossette S, Frasure-Smith N, Lesperance F. Clinical Implications of a Reduction in Psychological Distress on Cardiac Prognosis in Patients Participating in a Psychosocial Intervention Program. Psychosom Med. 2001;63:257-266.
34. Frasure-Smith N, Lesperance F, Prince RH, et al. Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. Lancet. 1997;350:473-479.
35. Ruberman W, Weinblatt E, Goldberg JD, Chaudhary BS. Psychosocial influences on mortality after myocardial infarction. N Engl J Med. 1984;311:552-559.
36. Case RB, Moss AJ, Case N, McDermott M, Eberly S. Living alone after myocardial infarction. Impact on prognosis. Jama. 1992;267:515-519.
37. Stanley MJ, Frantz RA. Adjustment problems of spouses of patients undergoing coronary artery bypass graft surgery during early convalescence. Heart Lung. 1988;17:677-682.
38. Moser DK, Dracup K. Role of Spousal Anxiety and Depression in Patients' Psychosocial Recovery After a Cardiac Event. Psychosom Med. 2004;66:527-532.
39. Moore SM. Psychologic distress of patients and their spouses after coronary artery bypass surgery. AACN Clin Issues Crit Care Nurs. 1994;5:59-65.
40. Langeluddecke P, Tennant C, Fulcher G, Barid D, Hughes C. Coronary artery bypass surgery--impact upon the patient's spouse. J Psychosom Res. 1989;33:155-159.
41. Lukkarinen H, Hentinen M. Assessment of quality of life with the Nottingham Health Profile among women with coronary artery disease. Heart Lung. 1998;27:189-199.
42. Rantanen A, Kaunonen M, Astedt-Kurki P, Tarkka MT. Coronary artery bypass grafting: social support for patients and their significant others. J Clin Nurs. 2004;13:158-166.
43. Santavirta N, Kettunen S, Solovieva S. Coping in spouses of patients with acute myocardial infarction in the early phase of recovery. J Cardiovasc Nurs. 2001;16:34-46.
44. Artinian NT. Spouse adaptation to mate's CABG surgery: 1-year follow-up. Am J Crit Care. 1992;1:36-42.
45. Beach EK, Maloney BH, Plocica AR, et al. The spouse: a factor in recovery after acute myocardial infarction. Heart Lung. 1992;21:30-38.
