If you have depression, you probably know all too well how this condition hurts your heart emotionally, but did you know that depression can take a physical toll on your ticker, too — and vice versa?

The relationship between depression and heart health is a two-way street. Depression increases your risk of heart issues by as much as 64 percent, according to the National Heart, Lung, and Blood Institute. And about one in five people with heart disease experience major depression, the American Heart Association reports.

So, how exactly are depression and the heart intertwined? Here are four ways depression is connected to your heart health, according to experts.

1. Depression Raises Your Risk of Cardiovascular Disease

“Depression is a well-known risk factor for cardiovascular disease, not just because of its psychological impact but also from the physiological standpoint,” says Rashmi Parmar, MD, an adult and child psychiatrist with Mindpath Health in Newark, California.

Cardiovascular disease, a group of disorders affecting the heart and blood vessels, is the number-one killer in the United States — and often a silent one at that, says the Centers for Disease Control and Prevention (CDC).

Heart disease, which is a type of cardiovascular disease, is often precipitated by a condition called atherosclerosis, according to the American Heart Association. Research shows that people with depression have an increased risk of atherosclerosis-related cardiovascular disease. One large study published in June 2019 in BMJ Open showed that adults ages 40 to 80 with depression have an increased risk of atherosclerosis-related cardiovascular disease.

Atherosclerosis affects blood vessels called the arteries, which are responsible for transporting oxygen-rich blood from your heart to the rest of your body. Over time, as you age, your arteries gradually stiffen, and plaque accumulates along the walls of your arteries. Many people with atherosclerosis don’t experience symptoms, especially in mild cases.

But in other cases, arterial stiffness and plaque buildup make it too difficult for blood to flow normally through your arteries. This can raise your risk of a heart attack or stroke, both of which are potentially fatal.

2. Depression Reduces the Likelihood You’ll Make Heart-Healthy Lifestyle Choices

Depression can make it difficult to even get out of bed, let alone exercise and cook nutritious meals for yourself every day.

In fact, people with depression are prone to unhealthy eating habits, not getting enough exercise, weight gain, and smoking, says Arvind Nirula, MD, an interventional cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.

“These are all risk factors for hypertension, diabetes, high cholesterol, and heart disease itself,” says Dr. Nirula.

3. Depression May Prevent You From Seeking Help for Heart Symptoms

Say you’ve already been diagnosed with depression, and you begin experiencing a heart-related symptom like a rapid heartbeat or chest pain. These symptoms, along with the thought of facing a serious health diagnosis, can be scary for anyone. But for people with depression, it may be overwhelming to even make an appointment with a doctor to discuss these symptoms.

“People with depressive symptoms may not have the energy or motivation to follow up with medical appointments,” says Ernesto Lira de la Rosa, PhD, a licensed clinical psychologist based in New York City and a media adviser for the Hope for Depression Research Foundation.

Nonetheless, it’s still very important to see your doctor if you experience any new symptoms. Depression and heart issues can even sometimes share symptoms, and a symptom you think is attributable to your depression may have another underlying cause. For example, “Depression and heart disease often have overlapping symptoms such as fatigue and anxiety,” says Rigved Tadwalkar, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California.

“For this reason, patients with these symptoms, along with symptoms and risk factors for heart disease, should be evaluated in a timely manner by their physician,” Dr. Tadwalkar advises.

4. Depression Can Follow a New Heart Diagnosis and Make It Worse

If you’ve recently had a heart attack, heart surgery, or been diagnosed with a heart condition like coronary artery disease (the buildup of plaque in the heart’s main arteries), it’s not uncommon to develop depression afterward, according to the Cleveland Clinic.

“Having a heart health condition may mean more doctor’s appointments, lifestyle changes, medication to manage the condition, and increased stress of having to adapt to a new way of life,” Dr. Lira de la Rosa says. “This can be overwhelming and lead some individuals to develop depressive symptoms.”

If left untreated, depression can make an existing heart condition worse and ramp up the risk of a heart attack, the Cleveland Clinic states. Untreated depression is especially risky for older individuals with coronary artery disease, according to a study published in August 2016 in the journal BMC Psychiatry.

“Research has shown that depression significantly worsens the prognosis for older patients with heart disease,” says Nirula. “In fact, depression is the strongest predictor of death in the first decade following the diagnosis of coronary artery disease.”

How Do I Know if I Have Depression?

If you haven’t been formally diagnosed with depression but suspect you have it, there are several signs to look for. According to the American Psychiatric Association, you may have depression if you’ve experienced any of the following symptoms for at least two weeks:

  • Down or depressed mood
  • Feelings of guilt or worthlessness
  • Difficulty concentrating or making decisions
  • Loss of interest in activities you used to enjoy
  • Restlessness or inability to sit still
  • Sleeping too much or too little
  • Slowed speech or movement
  • Suicidal thoughts or behaviors
  • Tiredness or lack of energy
  • Unintended weight gain or loss

How to Protect Both Your Heart and Mind

Getting help for depression is incredibly important to preserve your heart health (especially if you already have heart problems). Standard treatment for depression involves visits to a mental health professional for psychotherapy, otherwise known as talk therapy, and in some cases medication.

People with chronic heart issues could benefit from seeing a mental health professional who works specifically with people with chronic illnesses. Your cardiologist may be able to help you find a therapist with knowledge about heart conditions. And if you’ve recently had a heart attack or heart surgery, you could also benefit from a cardiac rehabilitation program, which is often covered by health insurance. According to Mayo Clinic, these programs are designed to aid in your recovery and often include counseling and emotional support.

If your doctor prescribes medication for you, make a plan to discuss with your doctor or therapist how to stick to it in the long run (and be sure to tell them about any other medications or supplements you’re taking to avoid potential drug interactions). Approximately 29 to 40 percent of American adults with depression have a hard time adhering to their treatment regimen, according to a study published in JAMA Psychiatry in November 2017.

Self-care — activities that help you take care of your well-being — is another strategy you can use to cope with depression. Many activities can count toward self-care, including:

  • Going to bed and waking up around the same time each day
  • Being physically active for at least 30 minutes a day
  • Eating nutritious foods, such as fruits and vegetables
  • Engaging in positive self-talk
  • Taking a shower daily
  • Meditating
  • Journaling

Although it can’t cure your depression, consistently engaging in self-care can help you feel better in the long run.

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