Suffering a heart attack brings most people face to face with their own mortality. It’s little wonder that distress and mood swings are commonplace among heart attack patients.
But what most people don’t know is that this psychological aftermath is completely normal, a psychological adjustment to a major physical event.
It is so common that psychologists and psychiatrists have coined a name for it, the cardiac blues. In 80 per cent of cases, these emotional signs last only a few months, but can be deeply felt and at times immensely confronting.
For most, these symptoms eventually pass. Yet, for one in five heart attack patients the anger, sadness and worry never disappear, instead developing into severe depression.
“Almost all patients really go through this. It’s so common that it is actually considered normal but hardly anyone knows about it until it has happened. If you just think about it yourself, if you had a heart attack tomorrow, you would be more than a little upset,” says Dr Rosemary Higgins, a psychologist and senior research fellow at Victoria’s Heart Research Centre.
“People collide head on with a very intense awareness of their mortality. That is a hard thing to be aware of. Even though we all know that we are all going to die, a heart attack brings it front and centre.”
Yet until as recently as year ago, the condition was little known even among health care professionals. A national campaign by the heart research centre and funded by Beyond Blue is quietly working to change that with an educational program aimed at both patients and professionals.
More than that, research by Dr Rosemary Higgins and Dr Barbara Murphy, the Research Director at the Heart Research Centre, has revealed particular “red flag” patterns of behaviour that are associated with both severe depression and a possible risk of death.
“Cardiologists and cardiac surgeons are extremely good at supporting a patient’s physical recovery but not so good at supporting someone’s emotional recovery, which is extremely complex,” says Dr Murphy.
“But we now that 20 per cent of cardiac patients develop severe depression compared to five per cent in the general population – that is a very high figure. We are starting to manage that better – two years ago the National Heart Foundation put in place national guidelines to screen for depression, but there are still people who go under the radar.”
Dr Murphy’s biggest concern is for those who leave hospital without being told what to expect.
“We see this every day in patients and we see it as normal adjustment, but if they don’t know about what can happen, they don’t think it’s normal. They might never have experienced these feelings before or this level of distress.
“It leads to all sorts of introspection – why am I feeling like this, why have I lost my confidence, why am I suddenly fearful of things, why am I crying when I have been one to cry? People catastrophise about their physical wellbeing: If they are a little breathless, they have an overwhelming fear that this is another heart attack again and I’m going to die.
“It spreads to undermine relationships with spouses or partners, with children, undermines confidence about work and creates a general sense of not being the same person.
“Patients need to know that this is likely to happen, doctors and nurses need to know too so they can inform the patients to expect a roller coaster ride with their emotions but also that these feelings will dissipate as your recover and get back to your old self. And that often happens within four months or so.”
Yet while that recovery comes as a matter of course for most, others experience a longer, darker journey.
“The one in five who develops depression after their cardiac event is much more likely to die,” says Dr Murphy.
“They are much more likely to have a second cardiac arrest and for it to be fatal in the years that follow. They also appear to be at risk of earlier death.
“We have looked at hundreds of death records and we clearly see elevated rates of depression among those who die at an earlier stage.”
The red flags identified by Dr Murphy and Dr Higgins are all indicators of risk for depression after a heart attack. They include: if a patient has had anxiety or depression in the past; regular use of cigarettes, drugs or alcohol; diabetes, financial problems, stress at work or home, the death of a love one, among several others.
All of these factors seem to make you more vulnerable to severe depression, says Dr Murphy. Surprisingly, only 30 per cent of heart attack patients go to cardiac rehabilitation programs. Dr Higgins says that many of those most at least are among the 70 per cent who drop out of therapy at a time when they most need it.
“If a patient is in the cardiac rehabilitation program, they have a much better chance of being identified as having the red flag risk factors and getting the appropriate psychological support they need.
“We need to be able to monitor their emotional trajectory, to screen them for these risk factors. If they don’t have them and are getting better, great. But if they are getting worse, then they’re trouble and need help.”
Red flag risk factors for depression after a heart attack:
You have had anxiety or depression the past.
You have no one to talk to.
You are stressed at home or work.
You have lost your job.
You have financial worries.
A loved one has died recently.
You have divorced or separated recently.
You regularly use drugs, alcohol or cigarettes.
You have diabetes.
You have other health problems.
Your mood is not getting better.
To find out more about the Cardiac Blues go to www.heartresearchcentre.org.