Depression After a Heart Attack: Why Does the Mind Struggle While the Heart Heals?

Why does depression after a heart attack happen and how is it recognised? Read about emotional strain after a heart attack or surgery and what families can do.

You came out of coronary intensive care, spent a few days on the ward and were finally discharged. Your doctor said, "The artery has been opened, you're doing well." Back home, climbing the three flights of stairs in your apartment block, you count the steps and listen to your heart with every breath. Weeks go by; your check-up results are fine, yet you are more tired, anxious and pessimistic than you have ever been. The chats at the local tea house you used to love, playing with the grandchildren, the garden jobs no longer mean anything to you. Depression after a heart attack is a mood problem that is common in people who have had a heart attack or heart surgery, yet it is often brushed off as "feeling a bit low". In this article I will try to explain why the mind can struggle while the heart is healing, which signs to pay attention to in this period and what both the patient and the family can do.

What Is Depression After a Heart Attack?

A heart attack is an event that comes suddenly, interrupts the flow of life and brings a person very close to death. Physical treatment is often carried out quickly; the problem in the heart's arteries is dealt with through angiography, a stent or bypass surgery. But the fear the person has lived through, the sense of loss and the shaken trust in their own life do not heal at the same speed.

Depression after a heart attack is a picture that appears after a cardiac event and shows itself through symptoms such as low mood, loss of interest, hopelessness and low energy lasting for at least two weeks. Research shows that depression is more common in people who have had a heart attack than in the general population and that, when it is not treated, it can make recovery harder. For this reason, monitoring the patient's mood is gaining ever more importance in cardiology as well.

This is seen not only in people who have had a heart attack; it can also occur in those who have had bypass surgery, valve surgery or a pacemaker fitted, or who have been diagnosed with heart failure.

Signs of Depression After a Heart Attack: Tiredness or Depression?

Feeling tired for a while after a heart attack, disrupted sleep or a reduced appetite can be a natural part of physical recovery. That is why depression is not easy to spot. The following signs need attention:

• Sadness, pessimism or numbness lasting most of the day,
• Listlessness that does not ease even though you are recovering physically,
• Loss of interest in people, activities and hobbies that used to bring enjoyment,
• Thoughts such as "I can never be the way I was" or "I'm a burden on my family",
• Reluctance to take part in cardiac rehabilitation, walks or check-ups,
• Irritability, impatience, getting angry quickly,
• Difficulty concentrating and making decisions,
• Frequent, disturbing thoughts about death.

Depression is often accompanied by intense anxiety. Listening to every heartbeat, constantly checking your pulse, rushing to A&E at the slightest twinge in the chest, or being unable to leave the house for fear of having another attack are all common in this period. The article on health anxiety offers more information on this kind of intense, body-focused worry.

These signs do not on their own mean a diagnosis; but if they continue for longer than a few weeks, it is important to share them with your cardiologist and with a mental health professional.

Why Does the Mind Struggle While the Heart Heals?

Coming face to face with death

For many people a heart attack is the moment when death becomes this concrete for the first time. The thought "I could have died that day" keeps going round in the mind even weeks after the attack. For some people this experience leaves deep questioning about the meaning of life; for others, a constant sense of being under threat.

Shaken trust in the body

Before the attack, the heart was an organ that worked without being thought about. After the attack, every palpitation, every twinge, every shortness of breath can be perceived as an alarm. When a person cannot trust their own body, they live constantly on alert, and this state of alertness increases both anxiety and tiredness. To understand the difference between the bodily symptoms of anxiety and symptoms coming from the heart, you can take a look at the article on the difference between a panic attack and a heart attack; but with any new or different chest pain, the assessment should always be left to a doctor.

Losing roles and independence

For someone who provides for the household, does the heavy jobs and is seen as the "pillar" of the family, suddenly being put in the position of "the patient who needs to rest" is a great loss. Taking a break from work for a while, not being able to drive, hesitating even when picking up a grandchild can leave a person feeling useless.

The burden of lifestyle changes

Giving up smoking, cutting down on salt, giving up favourite foods, walking regularly and taking medication without missing doses... Each of these changes is a challenging process on its own. When they all come at once, with the pressure of "if you don't, you'll have another attack", a person can feel besieged. Someone whose ways of relaxing, such as eating habits and smoking, have been taken away has also lost the tools they used to cope with their feelings.

The intensive care experience

The days spent in coronary intensive care: the sound of the monitors, the cables, the sleepless nights, what other patients went through... For some people this environment leads to nightmares, sudden startle reactions and reliving those days over and over in the mind, even after they have been discharged.

Shifting Balances in the Family: "Don't Tire Yourself Out" and Overprotection

In our country, the home of someone who has had a heart attack practically turns into a visiting centre in the first weeks. Relatives, neighbours and former colleagues come to wish them a speedy recovery. This attention is valuable, but constantly hosting guests can tire a person who needs to rest, and telling the same story over and over can keep the fear alive.

The family's attitude also changes over time. The sentence "Don't upset your father, he has a heart condition" can become a rule in the home. The spouse watches the patient's every move: "Don't lift that", "Take the stairs slowly", "Put that salt cellar down." This anxiety is an expression of love; but it can make the patient feel like a child and make it harder for them to regain trust in their own body. At the same time, important matters begin to be hidden from the patient at home "so they won't get upset", and the person may feel shut out of their own family.

Let's say a shopkeeper with a few years to go before retirement has to hand his shop over to his son after a heart attack. So as not to tire him, the family tells him nothing about the shop. He spends his days at home in front of the television, grows steadily quieter and often says, "I'm no use to anyone any more." His family, meanwhile, thinks this is just "low spirits". Yet giving him a controlled role, to the extent his doctor allows, for example making room for him to drop into the shop briefly a few days a week or to take part in decisions as an adviser, could have a positive effect on both his sense of identity and his mood.

What Can Be Done to Protect Mental Health After a Heart Attack?

• Join a cardiac rehabilitation programme: These programmes, available at many hospitals, rebuild trust in the body by teaching you to exercise under medical supervision. Being among people going through a similar process also reduces the sense of loneliness.
• Make a "symptom plan" with your doctor: Clarifying in advance which symptoms mean you should rest, which mean you should call your doctor and which mean you should call 112 (emergency services) reduces the uncertainty and panic that come with every twinge.
• Increase activity in small steps: Walking a little further each day, within the limits your doctor recommends, is a good investment for both heart and mental health. Noting your progress in a notebook provides concrete evidence against the thought "I can't do anything".
• Make changes one after another, not all at once: Rather than trying to change everything in a week, set an order of priorities together with your doctor. Getting support to stop smoking can also be part of this process.
• Plan your return to work gradually: If you work, think of returning to work as a transition, following the timing your doctor recommends. If possible, starting with shorter hours or lighter duties in the first weeks creates a safe space to test both your body and your worry about "Will I be able to do it like before?" Telling one person you trust at work about your situation means you will not be alone in a moment of sudden tiredness.
• Organise the visits: Give one person in your family the job of planning visits. Saying that you need to rest is not rude.
• Talk about your feelings: Share your fears, anger or sadness with your spouse, your children or a friend you trust. The effort to "look strong" is one of the things that drains the most energy.
• Have a role in life: Small but meaningful responsibilities, such as doing homework with a grandchild, taking on a task in the neighbourhood association or looking after the garden, help you feel valuable again.

For families

While protecting the patient's limits, take care not to push them into a completely passive position. Saying "Let's look together at how much the doctor has allowed" instead of "Don't do that" gives control back to them. Do not neglect your own anxiety either; facing the possibility of losing someone you love is a shaking experience for spouses and children too.

When Should You Seek Professional Support?

It is important to talk to a mental health professional in the following situations:

• If low mood, hopelessness or listlessness has continued for longer than two weeks,
• If, because of anxiety, you cannot leave the house or take part in walks or the rehabilitation programme,
• If you are clearly struggling to keep up the recommended treatments and lifestyle changes,
• If nightmares and intrusive images of intensive care or the moment of the attack continue,
• If relationships within the family are under constant tension.

If you are having thoughts that life is meaningless or thoughts of harming yourself, share this immediately with someone close to you and with your doctor; in an emergency, call 112 (emergency services). With physical symptoms such as chest pain, shortness of breath or fainting, you also need to reach 112 without delay. Whether depression needs to be supported with medication should be decided by a psychiatrist, in cooperation with your cardiologist, in a way that is compatible with your heart treatment.

How Is Depression After a Heart Attack Approached in Therapy?

The first step in therapy is to listen to the person's experience as a whole: the moment of the attack, the hospital process, coming home and what has changed since. Many people find the opportunity to tell someone about those days from beginning to end for the first time. Within the framework of cognitive behavioural therapy, work usually focuses on the following areas:

• Interpretations of bodily sensations: Assessing catastrophising thoughts such as "There's something in my chest, another attack is coming" in a more balanced way, in the light of the symptom plan made with the doctor.
• Reducing avoidance: Gradually returning to the walks, social settings and responsibilities that were dropped because of anxiety.
• Behavioural activation: Bringing small, enjoyable and meaningful activities back into daily life without waiting for mood to improve first.
• Loss and identity: Building a new pattern of life while grieving changed roles, lost habits and the "old me".
• Communication with the family: Finding a healthy balance between overprotection and neglect.

A heart can be repaired with surgery; but learning to trust it again takes time, patience and, often, a companion on the road.

You can read about how depressive symptoms are worked on in this process on the depression and mood page. Because travelling can be tiring in the first weeks after discharge, sessions can also begin online.

Frequently Asked Questions

Does depression affect heart health?

Research shows that there is a two-way relationship between heart disease and depression. Depression can have a negative effect on recovery by making areas such as physical activity, nutrition, sleep and sticking to treatment harder. That is why it is important to take mood as seriously as heart health.

I panic at every twinge in my chest. What should I do?

This is a very common experience. First, clarify with your doctor what each symptom means and when you need to get emergency help. If anxiety is running your day even though there is no clear medical cause, getting psychological support to regulate your relationship with bodily sensations is helpful.

My father has become very grumpy since his heart attack. How should we behave?

Irritability and impatience can be one of the important signs of depression, especially in men. Rather than constantly warning him, asking about his feelings, involving him in decisions and giving him small roles in which he feels valued often helps more. If it continues, you can gently suggest that he talk to a professional.

I've been crying a lot since the attack. Is this normal?

After a close encounter with death, it is quite common for emotions to intensify, to be easily moved and to cry. This can be part of the mind processing the shock it has been through. But if the crying spells increase as the weeks pass and come together with hopelessness and listlessness, it is a good idea to talk to a professional.

• #heart attack
• #after bypass surgery
• #heart disease
• #health anxiety
• #family carers

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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