Cardiovascular Disease and Mental Health

A brief look at symptoms of depression

Depression is a complex and multifaceted condition that can have a variety of causes as well as treatments. Many people experience the symptoms of this mental disorder differently, and what may appear as a concern for one person may not for another. That being said, it’s useful to be aware of the general experiences of those with depression in order to spot it early and prevent its development.

Those who are clinically depressed may have a persistently low or bad mood. Low moods are generally accompanied by feelings of low self esteem, tearfulness, guilt, and anxiety. Sufferers may also feel irritable, have a lack of motivation, or find it difficult to make decisions. Most dangerously, those with depression may have suicidal thoughts or a desire to self harm. If depression has progressed to this stage for you or someone you know, it’s critical that you seek out help immediately. 

Here are some useful links that can be of help, or offer support to those who are suffering from depression or suicidal thoughts:

https://www.nhsinform.scot/illnesses-and-conditions/mental-health/mental-health-self-help-guides/depression-self-help-guide

http://www.bipolaruk.org/ 

http://www.apni.org/ 

Anxiety symptoms and heart disease

Anxiety often accompanies depression, but it can be experienced on its own as well. Like depression, anxiety is a complex condition with many causes. However, the most common causes of anxiety are stress. Anxiety can also be a side effect of some medications.

Anxiety symptoms often involve increased heart rate, increased blood pressure, and heart arrhythmia (irregular heartbeat). All of these symptoms can have a negative effect on heart health, as they disrupt the circulatory system’s natural flow, and place stress on the heart. According to the Cardiovascular Group, persistent anxiety attacks can cause lasting damage to the heart, and may increase one’s risk of heart attack, heart failure, and even stroke, by 26%. Unfortunately, since anxiety disorders are commonly characterised by feelings of uneasiness and fear, recovering from or managing heart disease can be especially difficult. This difficulty may occur when those suffering with anxiety have trouble following a medication regimen, keeping a healthy diet, or getting the proper amount of sleep. These factors can then act in a feedback loop with coronary events, making it seem like recovery or healing is impossible. Thankfully, there’s plenty of methods for treating anxiety as well as heart disease, and talking to your doctor about symptoms can help you develop a useful treatment plan.

Depression and heart disease

Although a causal link between depression and heart disease is difficult to establish, it’s certainly true that depression is normally accompanied by other risk factors for heart disease. These factors include a lack of sleep, anxiety attacks, and a sedentary lifestyle. 

Research has found that one in five patients may go on to develop depression after the onset of a heart attack. This phenomenon likely occurs due to ill feelings about health, uncertainty of the future, and guilt about previous actions that may have influenced the occurrence of the heart attack. However, severe depression can have a serious impact on one’s ability to recover in a similar way to anxiety, as sufferers may find it difficult to follow a medication routine, change their diet, and sometimes resume habits that damage health (such as smoking and drinking). 

There’s plenty of support for those recovering from a heart attack. These support networks often take the form of regular cardiac rehabilitation, social groups related to heart disease, and psychiatric care. There’s great evidence to suggest that a positive outlook can greatly increase the likelihood of recovery from a heart attack. Those who remain optimistic, stick to their treatment plans, and proactively manage their health can often make a full recovery from heart-related problems. 

Severe mental illnesses and heart disease

Bipolar disorder and heart disease

Bipolar disorder is characterised by severe, extreme mood swings. Sufferers of bipolar disorder may have episodes of intense depression, followed sometimes quickly by a high or overactive feeling - usually referred to as mania. 

These intense mental shifts can greatly affect the body’s physiology, causing heart rate and blood pressure to increase and decrease quickly and randomly. As a result, those with bipolar disorder are at an increased risk of developing arteriosclerosis, a disease that causes the hardening of arterial walls from plaque buildup. This may be exacerbated by unhealthy behaviours people with bipolar disorder may partake in during manic episodes, such as smoking and alcohol abuse.

The key to managing the development of heart disease in those with bipolar disorder is stabilising mood swings. This process can be difficult, and what works for some may not for others. The most common treatments for bipolar disorder are medication, avoiding triggers, and consistent therapy. 

Schizophrenia and heart disease

Schizophrenia is a rare but severe mental disorder sometimes accompanied by hallucinations, disorganised speech, trouble thinking clearly, lack of motivation, paranoia, depression, and anxiety. Schizophrenia is not curable, but it can be effectively managed with the right medications. Its impact on heart disease is similar to that of depression and anxiety disorders, where the irregularities experienced by the circulatory system as a result of mental illness symptoms can lead to cardiovascular disease, hypertension, and heart attack.  

These chronic conditions are exacerbated by other risk factors that can accompany schizophrenia, such as drug abuse, smoking, and an unhealthy diet. Studies have estimated that sufferers of schizophrenia are three times more likely to experience sudden cardiac death, and heart disease related events are the leading cause of death among schizophrenics. The good news is that schizophrenia is manageable, treatable, and those with the condition can go on to lead lives free from heart disease. 

Posttraumatic stress disorder and heart disease

Post-traumatic stress disorder (PTSD) can occur as a result of any deeply traumatic experience, and its symptoms often include flashbacks, nightmares, anxiety, and difficulty sleeping. 

Like other mental disorders, PTSD symptoms send a cascade of stressors through the body, having a lasting physiological effect that can eventually lead to heart disease. Furthermore, the intense flashbacks or triggers may cause a sufferer to experience a heart attack or other myocardial event. 

Treatment for PTSD depends on its severity and cause, but proactive symptom monitoring, antidepressants, and psychological therapies are all effective tools for managing the condition. 

Reaching out and talking to someone

Talking to a professional about mental health is the first step toward managing a disorder. A doctor can refer you to a mental health specialist, either for your specific condition or simply for general therapy. Additionally, if mental illness has started to affect your ability to perform daily functions, like hygiene, eating, or sleeping, then getting immediate help is vital. Finally, if you or someone you know is experiencing suicidal thoughts or the desire to self harm, seek emergency medical attention. 

What can I do to have a healthier lifestyle?

Being active

Being active can not only reduce your risk of heart disease, but also of experiencing mental illness. Exercise triggers the release of endorphins that leave a lasting feeling of happiness. These chemicals are a key factor in combating depression. If you’re living a more sedentary lifestyle, it’s okay to start small. A short walk every evening or in the morning is a great way to get the body moving and begin the journey of daily exercise. 

Eating a healthy balanced diet

Similarly to staying active, having a balanced diet can both prevent the onset of heart disease and improve mental health. Your body depends on nourishing food to keep a chemical balance in the brain, allowing your mind to remain healthy. Furthermore, setting a diet goal can help eliminate feelings of poor self-esteem, and improve motivation. 

Cutting down on alcohol and quitting smoking

Alcohol also influences the likelihood of developing heart disease, and is commonly used as a way to relieve stress for those with mental disorders. Drinking alcohol in moderation may be okay, but if you begin to develop an unhealthy relationship with drinking, it can only exacerbate the symptoms of mental illness. Likewise, smoking is one of the top risk factors for heart disease and is often used by those with depression or anxiety as a stress relieving activity. For this reason, quitting can be especially difficult. Kicking these habits can be especially hard, but there are loads of resources or support groups available to help.

Weight

Obesity has a direct impact on the development of heart disease, and may also accompany mental struggles like depression and anxiety. Some sufferers of mental disorders become overweight due to symptoms of lethargy that accompany mental illness. However, some people may develop mental illness as a result of being obese whether that be related to a lack of physical activity, poor self esteem, or other comorbidities. Weight goes hand-in-hand with diet and exercise, and managing both usually leads to improvements in the former. That being said, initiating the process of diet and exercise can seem daunting. The best option is to start small, go for a walk every day, develop a meal plan, and encourage yourself to reach your goals. 

Summary

In summary, heart disease and mental health are certainly linked. Whether that be because of the impact mental illness has on the physiology of the body, or because of the risk factors that accompany its development. However, mental illness is perfectly manageable with the right tools, help, and potentially medication. The same can be said for heart disease. So long as you proactively engage with your health and resume autonomy over your health choices. 

References

  1. Hopkins Medicine. Anxiety and Heart Disease [Internet]. [cited 1 Mar 2022]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/anxiety-and-heart-disease
  2. Hopkins Medicine. Depression and Heart Disease [Internet]. [cited 1 Mar 2022]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/depression-and-heart-disease
  3. McQuillan, S. Is Bipolar Disorder Increasing Your Risk of Developing Heart Disease? [Internet]. Psycom [updated 4 Jun 2019; cited 1 Mar 2022]. Available from: https://www.psycom.net/bipolar-disorder-and-heart-disease/
  4. UC San Diego Health. More Links Found Between Schizophrenia and Cardiovascular Disease [Internet]. [updated 31 Jan 2013; cited 1 Mar 2022]. Available from: https://health.ucsd.edu/news/releases/pages/2013-01-31-links-between-schizophrenia-and-cardiovascular-disease.aspx
  5. De Hert, M, Detraux, J, Vancampfort D. The intriguing relationship between coronary heart disease and mental disorders. Dialogues Clin Neurosci. [Internet] 2018 [cited 1 Mar 2022]; 20(1):31-40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016051/
  6. Jindal, R. MacKenzie, EM, Baker, GB, Yeregani VK. Cardiac risk and schizophrenia. J Psychiatry Neurosci. [Internet] 2005 [cited 1 Mar 2022]; 30(6): 393-395. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1277021/
  7. American Psychiatric Association. What Is Schizophrenia [Internet]. [cited 1 Mar 2022]. Available from: https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
  8. Arensen, M, Cohen, B. Posttraumatic Stress Disorder and Cardiovascular Disease. PTSD Research Quarterly. [Internet] 2017 [cited 1 Mar 2022]; 28(1): 1-9 https://www.ptsd.va.gov/publications/rq_docs/V28N1.pdf

Kristen Bowles

Masters of Science - MSc Epidemiology Student, London School of Hygiene and Tropical Medicine, England
Kristen graduated as Summa Cum Laude and is now pursuing Masters of Epidemiology in LSHTM.
Experienced in cultural anthropology from the University of St. Andrews, and hopes to continue working in Europe with a special focus on medical mistrust and how these social factors influence health data, equity, and disease spread.

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