Don't Go Breaking Your Heart
Stressed about work? Depressed about a relationship?
Bummed about life in general? Well, snap out of it!
Because if you don't, it will be your heart that snaps.
Two years ago, I decided to make a radical life change. With my two dogs, nearly a dozen cats and three chickens in tow, I drove a rented van 280 miles to a new home in a small town in upstate New York. But about halfway through the trip, I became despondent, emotional and panic-stricken.
And my passengers, howling and crying behind me, didn’t sound like they were handling the move any better. My mind raced uncontrollably. I had spent months planning and preparing for this move.
Why on earth, I asked myself, was I leaving behind a comfortable house in the New York City suburbs, a steady job, a pleasant lifestyle, and friends and family I loved?
The feelings of guilt, apprehension and uncertainty caused a resounding sadness that ran so deep it hurt to breathe. And weeks after settling into my new life, I still found it difficult to function. I had trouble sleeping and eating, I lost weight and I felt overwhelmed by the simplest tasks. I had to come to grips with the fact that, officially, I was clinically depressed.
I already knew what most people know about the factors that define depression—sadness, pessimism, anxiety, lack of energy, sleep disorders, disinterest in sex, and appetite and weight fluctuations. I even knew that the combination of such depressive symptoms triggers spikes in blood pressure and can hamper the immune system. What I didn’t know, and what millions of other people also don’t know, is that a high level of stress and clinical depression can lead to heart disease.
Here’s a depressing statistic: Nearly one in 20 American adults experiences major depression in a given year. Add to that stat the one in three people who suffer from depression after being diagnosed with heart disease or surviving a heart attack. Despite enormous advances in the understanding of brain chemistry and societal acceptance of the condition, depression often goes undiagnosed and untreated, with only about one-third seeking help, reports the National Institute of Mental Health (NIMH).
In a domino effect, the emotional distress that causes depression can set off considerably more serious physical symptoms, such as irregular or rapid heartbeat, high blood pressure, elevated insulin and cholesterol levels, and faster blood clotting (Depression and Anxiety 1998). A depressed individual may feel just slightly apathetic and sluggish, yet internally his or her stress hormones could be soaring, increasing the heart’s workload. The combination of these risk factors is a potential recipe for a cardiac catastrophe.
A six-year study of 4,500 heart-healthy people 65 and older suggested that the mental stress which accompanies depression could encourage the blockage of blood vessels and help create a hospitable climate for heart disease. As the study progressed, participants who struggled with depression were 40% more likely to develop cardiac disease than those who were more lighthearted (Circulation 10/00).
More so than men, women are prone to depression, and heart disease is the number-one killer of women. More than 70% of the women polled felt “depressed, stressed, anxious or sad” within the past year, according to a 2004 survey by Harris Interactive. A woman who experiences just one significant episode of depression has increased odds of developing metabolic syndrome, a cluster of conditions—including abdominal obesity, high blood pressure, and elevated blood sugar and cholesterol levels—that set the stage for heart disease, reports Psychosomatic Medicine (5-6/04).
According to the American Heart Association (AHA), men beset by depression face the same heart hazards as women, and those afflicted with the blues may be twice as likely to die of a stroke.
The Psychic Connection
Even though research supports a connection between depression and the physiological responses that may encourage cardiovascular disease, the link is not a direct one. The more likely scenario, say experts, is that depression causes the behaviors that lead to heart problems.
“People who are depressed don’t always take care of themselves very well and that can cause them to develop heart disease, especially if there are genetic factors involved,” says Lloyd Fallowes, MD, creator of the cardiac stress test (with Stuart Rosner, MD) at Long Island Jewish Medical Center in 1967. This heart-health test, which measures physical condition, blood flow and heart function, remains the gold standard used today.
Depressed persons, says Dr. Fallowes, may be more likely to engage in behaviors that predispose them to heart disease, such as smoking, eating poorly, leading a sedentary life and neglecting genetic factors. “But just because an individual is depressed,” says Fallowes, “it does not mean he or she will develop heart disease or that he or she is going to die. They have a choice of doing the right thing for themselves. We all have the choice to do the right thing.”
Wayne Sotile, PhD, director of psychological services at Wake Forest University’s Cardiac Rehabilitation Program, and author of Thriving with Heart Disease (The Free Press), agrees: “Without question, a person who flounders in untreated depression for many years is more likely to develop heart disease.” In addition to engaging in the poor health behaviors cited above, Dr. Sotile says that depressed people are much less likely to follow medical advice. “Therefore, they are more liable to suffer the effects of untreated conditions like diabetes, high blood pressure or high cholesterol—conditions that can be controlled with medication.”
An unhappy childhood and adolescence may also be a precursor of cardiovascular problems. Not only are troubled kids and teens more likely to indulge in risky behavior such as smoking, and drug and alcohol use, but also they may internalize experiences of abuse. According to the Journal of the American Medical Association (9/04), adults who reported experiencing traumatic emotional, physical or sexual abuse during childhood had a 30% to 70% greater chance of developing ischemic heart disease then those who reported more typical childhood experiences. These same survivors of childhood trauma were more likely to endure diabetes, obesity and hypertension, all contributors to heart disease.
Heart Disease Blues
People who have been told they have heart disease have to deal with an emotional distress that can put additional strain on the heart, dramatically increasing the risk of another heart attack and even predicting an earlier death. Depressed individuals with cardiovascular disease are less prone to adhere to exercise and smoking-cessation programs, far less apt to enroll in cardiac rehabilitation and less likely to follow recommendations to reduce cardiac risk, even finding it difficult to take medications (Archives of Internal Medicine 2000).
“Among heart patients, depression is as good a predictor of imminent death as smoking, obesity or a previous heart attack,” writes Dean Ornish, MD, in Love and Survival: The Scientific Basis for the Healing Power of Intimacy (HarperPerennial). “Study after study shows that people who are lonely, depressed and isolated are three to five times more likely to die prematurely than people who feel a connection to their life.”
Depressive symptoms can affect heart and overall health more than actual heart function, making people with heart disease feel far worse than their tickers would indicate. Within a group of 1,024 adults with heart disease, those who were depressed demonstrated a history of heart attack or diabetes, higher body mass index, a lower capacity for exercise, a lower income and, perhaps most significantly, less close relationships and social support (JAMA 7/9/03).
In addition to depression, an absence of hope for a healthy future can foster depressive and despondent thoughts, coloring a person’s beliefs about his or her health. “Individuals with heart disease become depressed because they are facing the concept that they will have a limited existence in the future,” says Dr. Fallowes. “Having heart disease, or any debilitating disease, will make a person depressed.”
Hearty Therapies and Treatments
When trying to conquer stress and depression, different treatments work for different people. Depending on the severity of depression, a healthcare professional could recommend antidepressant medications or psychotherapy. “Talk” therapy provides a forum for expressing and exploring issues and feelings. Medications may also lessen depressive symptoms, but must be monitored for side effects and possible negative interactions with other medications.
Once dismissed as ineffective, treatments based on non-conventional traditions and practices are working for people who do not respond to conventional therapies. Homeopathy (based on the principle that signs and symptoms of an illness can be treated with a substance that induces the same symptoms), Chinese medicine, Ayurvedic medicine and acupuncture, are garnering interest in the West by qualified professionals. In fact, these treatments have effectively alleviated mild to severe symptoms in depressed individuals.
Herbal remedies have also proven effective in treating depression. In a 2003 study involving 521 doctors and 2,462 depressed patients, researchers concluded that mild to moderately severe depression can be treated successfully with a combination of St. John’s wort extract and valerian.
Exercise is a win-win strategy for anyone dealing with depression. Physical activity reduces the effects of stress and raises “feel good” brain chemicals, improving mood and heart health. Exercise training can provide the same mood-altering effects as an antidepressant medication.
It appears that the line about the “power of positive thinking” is more than just a cliché; that looking at life’s glass as half-full instead of half-empty or that we shouldn’t sweat the small stuff can have direct benefits on the health of our minds, bodies and hearts. Stress management, dietary changes and attention to overall fitness just may put you in a better state of mind, enabling you to lead a heart-healthy, happy life. Out here in the countryside, I’ve come to learn that positive thoughts can accomplish wonders.