Depression Can Sink a Failing Heart

Heart failure patients with depression had a much lower survival rate

(RxWiki News) Positive feelings can make a world of positive difference in a person’s health. For patients with failing hearts, however, negative feelings and depression can have the opposite effect.

When you’re feeling down, your physical health can decline as well.

In a new study, researchers observed that heart failure patients who were moderately or severely depressed had four times the risk of dying and two times the risk of having to go to the emergency room or being hospitalized.

"Keep up a positive attitude."

Alanna Chamberlain, PhD, assistant professor of epidemiology in the Department of Health Sciences Research at the Mayo Clinic in Rochester, Minnesota, evaluated data on 402 patients with heart failure.

In some ways, heart failure is a misleading term because the heart is still working, but it cannot pump enough blood through the body. The condition develops over time as the pumping action of the heart gets weaker, according to the National Institutes of Health.

The heart failure patients in this study were an average age of 73, and 58 percent were male.

Dr. Chamberlain and her colleagues recorded 59 percent of patients as having no depression, 26 percent with mild depression and 15 percent with moderate-to-severe depression.

Even those who reported mild depression had almost a 60 percent increased relative risk of death compared to those without depression, as well as a 35 percent increased risk of emergency room visits and a 16 percent increased risk of hospitalizations, according to the authors.

About a third of the patients with moderate-to-severe depression were taking antidepressant medication. Depression may be under-diagnosed in these patients.

Some may have been undergoing therapy that did not include prescription drugs, researchers said.

“Depression is a key driver of healthcare use in heart failure,” said Dr. Chamberlain.

“Treatment programs should be tailored to each patient’s needs with greater emphasis on managing depression either through medication or lifestyle interventions.”

It is common to feel sad or depressed after a heart attack, cardiac surgery or procedure, recent hospitalization or new diagnosis of heart disease, according to the Cleveland Clinic.

Up to one third of heart attack patients end up developing some degree of depression, said Barry Jacobs, PsyD, a clinical psychologist and director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania, in a statement on the American Heart Association website.

Dr. Jacobs recommended counseling and/or medication to treat depression.

Physical activity can have powerful mood-lifting effects. Connecting with others can also help beat the blues.  Some other tips that may help include getting enough sleep, maintaining a healthy diet, joining in enjoyable activities, volunteering, taking care of a pet or learning a new skill.

“Further research is warranted to develop more effective clinical approaches for management of depression in heart failure patients,” said Dr. Chamberlain.

The study was published in March in Circulation: Heart Failure, an American Heart Association Journal. The National Heart, Lung, and Blood Institute and the National Institute on Aging funded the study.

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Review Date: 
March 18, 2013