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Straight Talk from 'Dr. Stephanie' - June 2013

Depression Revisited
En español

Stephanie Coulter, MDI have written before about how depression, if left untreated, can have a negative effect on heart health, especially for women (Depression Hard on Hearts).

Studies have shown a strong link between depression and increased risk of cardiovascular disease and for those who have had a heart attack, added risk for a second attack.

In fact, eight studies — including 15,613 patients followed for 153,031 patient-years — have robustly shown that depression increases the risk of a first cardiac event in patients without any prior history of heart and vascular disease.

What is depression like for heart attack survivors?

Depression after a cardiac eventFor those recovering from a heart attack, depression can be among a mix of strong feelings about what has happened to you.  

Denial, anger, fear, anxiety, and depression are common emotions among heart attack survivors. These are normal reactions, and you should talk about these feelings with your doctor. 

Feelings of depression may last for several months. Common signs of depression include 

  • sleep problems
  • not feeling hungry
  • feeling very tired
  • not caring about things that used to be important to you 
  • having a low self-esteem 

Some patients may need professional help and medicine for depression.

It is very likely that your family, friends, and coworkers will be affected by your heart attack as well. They will have concerns about your future and questions about your condition. Lifestyle changes, even something as simple as a new diet, may cause stress within your family.

Depression can and should be treated

Treatment of depression includes pharmacologic therapy (medicines) and behavioral therapy. 

A positive attitude toward recovery and treatment can help a lot as you struggle to deal with your feelings. Your physical recovery is not the only recovery that can begin in the hospital. Emotional and mental recovery can begin there as well. When you are ready, your doctor can talk to you about what has happened, why it has happened, and what your treatment options are. Understanding and accepting your condition are the first steps toward a good mental outlook. Supportive friends and family are also very important.

The negative feelings you have after a heart attack usually will pass as you recover and slowly return to your normal activities. 

You can also get into a support group and/or a cardiac rehabilitation program to get added counseling and emotional support as you come to grips with your post-heart attack feelings.

Are you at risk? 

A simple 2-question assessment, the Patient Health Questionnaire-2 (PHQ-2) has been validated to identify currently depressed patients and is endorsed as a screening tool in cardiac patients by the American Heart Association (AHA) AND the American Psychiatric Association, as well as others.

 Choose one answer for each question from the PHQ-2:

1. Little interest or pleasure in doing things?

a. Not at all
b. Several days
c. More than half the days
d. Nearly every day

2. Feeling down, depressed, or hopeless? 

a. Not at all
b. Several days
c. More than half the days
d. Nearly every day

Now, score your answers by adding up the points:
a=0; b=1; c=2; d=3.

If you score 3 or more on the PHQ-2, this indicates the need for a 5-minute, 9-question screening test called PHQ-9.

[To see PHQ-9 questions, and learn more detail about Patient Health Questionnaires, read "Identify and Treat Depression for Reduced Cardiac Risk and Improved Outcomes" Texas Heart Institute Journal. 2012; 39(2): 231–234.]

Get help  

As always, listen to your body. If you think you may be experiencing cardiac problems, don't hesitate, get help quickly.

If you have already experienced cardiac problems and are having difficulty adjusting to your new reality, don't go it alone, seek help.  

Until next time!
Stephanie Coulter, MD, Director of the Center for Women's Heart & Vascular Health
Stephanie Coulter, MD    


Do you have a topic that you would like to learn more about from Dr. Stephanie? Send us an email at and your question may be the next Straight Talk topic!

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