Heart Health, Depression and the Impact of Everyday Choices

February 18, 2020

Life is demanding. Chances are that most days, you’re focused on what you need to get done – powering through the workday, checking off personal to-do lists, taking care of your family – and just hoping you’re able to keep it all straight. Often, we look for shortcuts to help us accomplish everything more efficiently, prioritizing ourselves last and rationalizing choices that can take a toll on our health if we’re not careful – like omitting physical activity from our routines because we’re “too busy,” choosing takeout over home-cooked meals and putting self-care on the back-burner because we regard it as less important. But, how often do you consider the impact that your lifestyle choices have on your heart – the fist-sized muscle that miraculously pumps millions of gallons of blood throughout the body, fueling your systems and keeping you breathing, moving and metabolizing?

Today, heart disease is recognized as the leading cause of death for men and women in the United States. We sat down to speak with Spira Care practitioners Dr. Debra McQueeney, PhD, and Dr. JasonBessey, DO, to learn about heart health, preventative care and how this common disease is directly impacted by everyday choices and mental health.

What is heart disease and how common is it?

Dr. Jason Bessey: Heart disease, specifically coronary artery disease, which is the most common type, occurs when arteries that supply blood to the heart muscle become narrow and hardened through the process of plaque buildup. It’s the leading cause of death for both men and women in the U.S., totaling about 647 thousand deaths per year, which accounts for about one in every four.

What is the two-way way relationship between heart disease and depression? 

Dr. Debra McQueeney: Depression can increase your risk for heart disease, and heart disease holds a fairly sizeable risk of being accompanied by depression. While there’s no definite causal pathway between the two, there are a several possible factors that likely contribute to their relation – namely, inadequate sleep, poor nutritional habits, infrequent exercise, lack of self-care and the increase in smoking or alcohol intake that is often triggered by depression.

Another important point that shouldn’t be overlooked is that depression and marital problems are closely related. And marital distress can predict health outcomes, having an effect on the metabolic system and sleep habits.

Additionally, often times with a depression diagnosis, anxiety goes along with it, which can cause a disruption in the individual’s reaction to stress. This means that the person could get more worked up in stressful situations, potentially causing abnormal cortisol levels, which also contribute to heart issues. 

When heart disease is coupled with depression and left untreated, what is the risk? Why is it so important to treat both? 

DM: We know that the prognosis for heart disease is poorer if you’re depressed and that depression can create inflammation, which is a physical pathway toward heart disease. If you’re diagnosed with the two, statistics show that you’re twice as likely to die.

JB: That’s why it’s vital to treat both. The most important thing regarding heart disease is reducing risk factors. So, if depression is a risk factor, it needs to be addressed.   

What are common behaviors someone goes through with a new heart disease diagnosis? What are ways a primary care doctor or behavioral health clinician can help? 

DM: After receiving this type of diagnosis, people often become extremely self-critical of their lifestyle choices that may have contributed to the disease. And self-criticism isn’t helpful – it’s a part of depression. You may also begin to feel very overwhelmed due to the changes that need to be made to deal with the illness. Of course, fatigue typically goes hand-in-hand with this, as the disease itself disrupts normal day-to-day functions.

JB: Other psychological behaviors we typically see are regret and guilt. Regret mainly because it’s a progressive disease. But you need to understand that while you can’t change your past behaviors, you can move forward and try to prevent progression. Treating the mental health side of things can definitely help with the healing process and coping with this new diagnosis.

DM: So, in terms of what we as providers can do for your behavioral health, it’s really important to focus on increasing their sense of self-worth and empowering them. We don’t just say, “do this, do that,” because that approach doesn’t work. Instead, all of our behavioral health consultants, health coaches and diabetic educators work with the individual person’s motivation and what stage of change they are in. The necessary lifestyle changes we “prescribe” are more than just information – it’s all about empowering.

We also help them gain perspective on their diagnosis. It’s easy for people to obsess over and be excessively negative about a chronic disease, so you want to approach the subject being compassionate and empathetic, but also reminding them that there’s something they can do to change it ­– it’s not forever.

Can someone with heart disease get back to activities they enjoyed before their heart event? How can physical activity have a positive impact on someone suffering with depression?

JB: After someone has a heart “event” of any sort, the most important thing is to make sure they are under some sort of care, whether that be from a primary care provider or a cardiologist, to make sure they are safely getting back to normal activities. This is different for everybody, people don’t just bounce back immediately – it’s a gradual process. 

Can someone have heart disease without ever experiencing a heart event?

JB: Not everybody who has signs of heart disease will necessarily have a heart attack or need some sort of medical intervention. It’s possible to have heart disease that doesn’t progress on and lead to any acute problems. A primary role that we play is figuring out how to reduce someone’s risk factors for developing a heart attack.

DM: One thing that plays an important role in this is self-care. Often times when we suggest self-care, members perceive it as selfish, likely because they are generally over-stressed and over-taxed between families and their workplace. If you have heart risk, depression or just about anything, you have to devote some time to self-care. Everyone should. If you don’t, it will catch up to you – the body is keeping score.

How can family members or friends help a loved one who has been diagnosed with a heart disease?  

DM: Families rise and fall together, so it’s extremely helpful for couples or families as a whole to be onboard with lifestyle changes. For example, it can be very difficult if only one person is trying to eat healthy or be more active within a family, while everyone else’s habits stay the same. Loved ones should be ready to offer support, whether that is in the form of choosing healthier meal options together or encouraging their loved one on their journey to quit smoking, so that the affected individual doesn’t feel isolated.

Does social stigma stand in the way of treatment for depression with members diagnosed with a heart condition? What do you want people to know to break down any stigma that is associated with this condition? 

DM: Absolutely, stigma gets in the way of any kind of behavioral health treatment. The best way to break it down is by what we’re doing here at Spira Care, focusing on whole person care, not just from the neck down. The more you see behavioral health in medical settings, the closer we get to reducing that stigma.

When it comes to heart health, there is a lot to be said for preventative care though making smart lifestyle choices. Check out The Blueprint for inspiration on how to stay active during the cooler months in our community, simple and healthy meal prep ideas from Chef Kyle, and helpful tips to help you manage everyday stresses.  

If you are a Spira Care member, you can make an appointment for a depression screening and/or a check-up appointment. Visit SpiraCare.com for more information.