Here’s a question for Heart Month: Did you know that heart and mental health are like the chicken and the egg? It doesn’t matter which one came first. Help one and you help the other.
One in 2 middle-aged men and 1 in 3 middle-aged women have some form of heart disease. Coronary artery disease (CAD) is still the leading cause of death in this country. CAD occurs when fatty deposits build up in the arteries that supply the blood flow to the heart. Over time, this narrows the arteries, restricts blood flow, and can lead to a heart attack or stroke.
When heart disease comes first
For people who’ve survived a heart attack, 33 percent will suffer from depression. Dr. Mia Wise, a medical director at Premera Blue Cross, said that the more severe the physical disease, the greater likelihood that the person also has developed a mental health disorder.
"When people have to go from seeing themselves as someone in good health to someone who has to make lifestyle changes and take medication to manage their condition, it has a big impact,” said Wise. “Patients can feel a loss of control. They may ask themselves, ‘Why me?’ or sometimes think, ‘What’s the point? Why should I try?’”
People who have heart disease may not be able to work, climb a flight of stairs, or even have the energy to go out to dinner. These changes and losses can lead to social isolation, anxiety and depression. Depression is associated with poor follow-through on post-heart attack treatment recommendations.
Jennifer Leisegang, a nurse and case manager for Premera’s Personal Health Support Program, sees this often. Up to 25 percent of the Premera customers she helps are living with a chronic heart condition.
"Many of my customers describe living with a chronic illness as exhausting,” Leisegang said. “Medications and attending multiple medical appointments can cause fatigue. People can be overwhelmed by their treatment plan, getting medications and supplies, navigating our health care system, trying to maintain relationships, and handling finances. Depression can be a side effect of having a chronic illness.”
When depression comes first
Research shows that depression is linked to heart disease. People with depression may sleep more, exercise less, eat a poor diet, and self-medicate with smoking, drinking, or substance abuse. They may have a hard time taking medications as directed by their healthcare provider. They’re less likely to do the things that keep them healthy and prevent heart disease.
“When you’re depressed, it’s really hard to advocate for yourself,” Wise noted. “If you have heart disease and depression, you feel physically lousy and think it’s all about the physical disease, when it’s not. People believe they should be able to think their way through a chronic disease like CHD. We need to change our focus.”
Hope for both
Shifting focus means getting everyone involved. While more cardiologists are screening for depression, primary care providers can screen their patients with the PHQ-2 or PHQ-9 questionnaires.
Providers can educate family members on the warning signs of depression, especially after a loved one has been diagnosed with CAD or had a heart attack. Wise recommends ongoing counseling, healthy habits like exercise and staying connected with a supportive network, and medication as a key part to managing the stressors of any chronic heart disease.
“Mental health and physical health aren’t separate,” Wise said. “We know that treating depression leads to better outcomes. It doesn’t matter where we interrupt this cycle, just as long as we interrupt it.”
Amy Irwin is in healthcare services communications at Premera Blue Cross.