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Stress and Its Adverse Effect on the Human Heart

Depression may both cause and complicate heart disease

By Second Opinion | June 15, 2012

Stress in your life causes stress on your heart. That stress can accelerate heart disease and can lead to a heart attack.

Depression and anxiety from stress tend to go hand in hand. If you suffer from one of these mental disorders it's likely you're also affected by the other. The latest medical research has added a third disorder to the mix, this time a physical one. Over the last decade researchers have raised the possibility that depression and anxiety can set the stage for heart disease as well as complicate its outcome.

Stress is an inevitable part of life. But just what is stress? Simply put, stress refers to the body's response to change. Of course, not all stress is bad and both good and bad stress affects different people in different ways. But continued ongoing stress can cause chronic anxiety and depression in some individuals.

How does stress affect the heart?

  • Anxiety and stress make your heart work harder. When you're under stress, your body's "fight or flight" response is triggered — your body tenses, your blood pressure rises and your heart beats faster.
  • Stress hormones may damage the lining of the arteries. When damage occurs, platelets in the blood adhere to the injured walls in an attempt to promote healing, resulting in a thickening of the arterial wall.
  • Stress releases fatty acids and glucose into the bloodstream. These can be converted into natural fat and cholesterol creating deposits that decrease blood flow.
  • Stress increases the likelihood that an individual will smoke, overeat, consume caffeinated beverages, self-medicate with drugs or alcohol and lead a sedentary lifestyle. (According to research from the University of Maryland, smoking cigarettes or consuming excessive caffeine can raise the heart rate an average of 14 beats per minute. This effect, when combined with stress, can cause the heart rate to increase as much as 38 beats a minute.)
  • Stress can interfere with the body's ability to repair itself, including slower repair of injuries to the heart.   
What Causes Stress?

Stress is part of every day living. Driving. Deadlines at work. Family disagreements. And not all stress is negative. A job promotion is equally exhilarating and anxiety-provoking. For some individuals, stress may serve as an adaptive response to important challenges, which can lead to outstanding performance and achievements. But, feeling too much for too long may have negative health consequences. Stress may arise from highly significant negative life events — like the loss of a job. Stressful life events have a clear association with heart disease. Chronic negative emotions have an insidious corrosive effect and may contribute to heart disease as well. 

These kinds of stresses may be caused by:
  • Lack of a sense of control over one's life.
  • Relentless time pressures.
  • Environments that contribute to low self-esteem.
  • Changes in lifestyle or environment that require adjustments.
  • Unsatisfactory social supports.
  • Poor health habits.
  • Poor coping skills.
  • Loss, including the biological vulnerabilities of aging.

Illness itself is profoundly stressful. For example, individuals who have had a heart attack and fail to adjust to their illness have higher death rates in the first six months after the event than their better-adjusted peers. And the demands of caregiving for a loved one can be extraordinarily stressful. Caregivers often ignores their own physical and emotional needs, sacrificing themselves to their task.   

How Is Stress Measured?

It's not easy to measure the effect of life stresses on any given individual's health or to predict how that individual will respond to it. But scientists have developed a number of instruments to help physicians and mental health professionals rate factors such as an individual's sense of powerlessness, hopelessness, hostility, anger, life event strains and coping skills.

It's difficult for an average individual to identify how much stress he or she has. If you believe you have stress or have unexplained symptoms you should talk to your doctor about it.  
  


Common symptoms of stress and depression:
Physical Emotional Mental/Behavioral
Restlessness Anxiety/worry Indecisiveness
Muscle tension Irritability/anger Inability to concentrate
Clenched jaws or grinding teeth Guilt Memory lapses
Heart palpitations Feeling powerless and frustrated Loss of sense of humor
Stomach disorders Negative thinking Aggressiveness
Poor sleep Crying Interpersonal problems
Headaches Apathy Loss of sex drive
Unusual weight gain or loss Mood swings increased use of cigarettes, alcohol or drugs
General aches and pains Sense of failure Changes in appetite
  Inability to see meaning in life  
Depression Can Accelerate Heart Disease

Both the heart and the head need to be treated appropriately.

Over the last decade, evidence has been mounting that depression may be a risk factor for heart disease, and conversely, having heart disease often causes depression.

Multiple studies suggest that those with depression are more likely to develop heart disease. In the case of a Johns Hopkins study of 1,000 male medical students, the increase was twofold. Other studies propose that the more severe the depression, the greater the risk.

While depression is an independent risk factor for the development of heart disease it's also an emotional reaction to heart disease itself.  According to the Journal of the American Medical Association, about 1 in 20 Americans experiences major depression in a given year but the number goes up to about 1 in 5 individuals who survive a heart attack.

The evidence that depression may both cause and complicate heart disease is getting stronger. But can treatment for depression prevent cardiac problems? 

Intuitively it would seem so, but researchers are just beginning to publish studies on the topic. One study from Duke University Medical Center found that a stress-management program cut the chances that a heart patient would suffer a heart attack or need surgery by 74 percent. Another from Emory University School of Medicine has found that giving the antidepressant paroxetine to heart attack survivors made their platelets less "sticky" and reduced their risks of developing blood clots. 

The conclusion, at this point, is that recognizing and treating depression is very important to maximize heart health as well as quality of life.

More than 80 percent of people with depression can be treated successfully with psychotherapy, medication or a combination of both. Physicians often recommend a patient with mild depression try cognitive behavioral therapy or interpersonal psychotherapy first. Medication can be added if needed or might be the first choice if the depression is more severe. For individuals with hearth disease, newer medications, like selective serotonin reuptake inhibitors are effective with fewer cardiovascular side effects than previous drugs. Family, friends and physicians all need to be aware of and watchful for the patient's tendency to dwell on thoughts of suicide.

You can take steps to control stress and fight depression. Talk to your doctor and consider getting guidance from a trained therapist.

Common coping techniques:
Life skills Relaxation Counseling
East and drink, sensibly Warm baths Get new perspective
If you smoke, stop Relaxing music Learn new behaviors
Exercise regularly Message Learn relaxation techniques
Get enough rest Deep breathing  
Recognize good things about yourself Stress relieving exercise  
Set reasonable expectations for yourself Meditation  
Say "no" to unreasonable demands Guided imagery  
Find time to relax every day Biofeedback  
Depression Is Not a Normal State of Mind

The transition from being depressed to being suicidal can be difficult to pick up.

Medical professionals today estimate that potentially 1 in 5 Americans will experience a diagnosable mental health disorder during a lifetime, including depression. That's 44 million adults and 4 million children. But it is not a normal state of being. For more information about depression and its treatment, see Second Opinion, Depression (Episode 201).

Suicide is the ninth leading reported cause of death in the United States. Statistics show that:
  • Almost all people who kill themselves intentionally have a diagnosable mental disorder.
  • The primary at-risk populations include young adults and elderly persons.
  • Although depression is more often diagnosed in women, more men than women die from suicide — more than a 3-to-1 ratio
  • As many as two-thirds of older individuals who complete suicide have seen a physician within a month of their death — according to one study, 20 percent of older patients who committed suicide visited their primary care physicians on the same day as their suicides.

Both doctors and patients often have difficulty identifying the signs of depression because it can show itself in so many different ways. Suicide can be even more difficult to predict.
  • Suicidal individuals may or may not give warnings of their intent.
  • They may be socially isolated, so there are no friends and family to help identify the seriousness of the situation.
  • Physicians are accustomed to treating patients who want to live rather than die — questions about suicidal ideation are normally not part of a routine medical evaluation.
  • Risk assessment techniques are imprecise.
Watching for Warning Signs

Many primary care physicians are becoming more proactive in dealing with depressed patients and sending them to mental health professionals.  The rest of us need to be vigilant as well with friends or family members who show signs of increasing depression.   

Warning signs include:
  • Expressions of hopelessness.
  • Admission of suicidal thoughts — those who admit to an organized plan of action are at greater risk.
  • Previous attempts at suicide or a family history of suicide.
  • Marked changes in behavior, attitudes or appearance.
  • Giving away prized possessions/putting affairs in order.
  • Lack of future plans.
  • Self-destructive behavior.
  • Withdrawal from friends and family.
  • Also see Signs of Stress and Depression.
Things you can do:
  • Ask the person if he or she has thoughts of suicide.
  • Actively listen and take what he or she has to say seriously.
  • Encourage the individual to identify things that might make a difference.
  • Persuade the individual to see a professional (if necessary, arrange it).
  • Take steps to help end the person's isolation.
This article reprinted with permission from Second Opinion, a public television health program hosted by Dr. Peter Salgo and produced by WXXI (Rochester, N.Y.),  West 175 and the University of Rochester Medical Center.