It’s no surprise that a health problem – especially a condition as serious as heart disease – can make you feel discouraged, sad or unmotivated.

But when those feelings coalesce into depression, the risks to mental and physical health multiply quickly. In fact, experts say the multiple, complex associations between depression and heart disease can create a “harmful loop,” with one condition feeding and exacerbating the other.

Studies show that depression is significantly more prevalent among those who have heart disease. So if you or someone you know is living with heart problems, it’s important to watch for signs of depression and seek help if needed, says Robert Theisen, PhD, a University of Vermont Medical Center staff psychologist.

“Depression is very treatable,” Theisen says.

Despite the prevalence of both heart disease and depression in the general population, patients may not always be thinking about the connection between the two.

This is true even among doctors: One national survey found that, while cardiovascular physicians generally were aware of the link between depression and heart disease, 71 percent asked less than half of their coronary artery disease patients about depression, and 79 percent did not use a standard screening method to diagnose depression.

But there is no shortage of studies showing – in the words of one 2009 medical journal article – a “multifaceted and likely bidirectional” relationship between the two conditions.

A review of nearly a quarter century of research found major depression in nearly 20 percent of heart attack survivors. That’s a big jump from depression rates in the general population: By comparison, the federal government says 7.1 percent of U.S. adults had at least one major depressive episode in 2017.

The same review found that a significant number of heart attack patients had continuing depression after discharge from the hospital, leading the authors to conclude that “depression is common and persistent” among those patients.

Theisen says such numbers are not surprising, given the potential impacts of heart disease on day-to-day life. “To the degree that it limits everyday activities that are meaningful to us … to the degree that it takes something away from us, it would be potentially cause for depression,” said Theisen, who works with patients rehabilitating from physical illness and injury at the medical center’s Fanny Allen campus.

He added that, “at the most basic, simple level, when you have heart disease, it’s a stressor that will be in the back of your mind even when you don’t necessarily consciously think about it.”

Theisen says it’s not uncommon to find physical factors causing mental health issues. But when it comes to depression and heart disease, the reverse also applies: Experts say depression is an “independent risk factor” for developing heart problems.

That’s partly because people with depression often are subject to “a cluster of cardiac risk factors” including diabetes and a greater body mass index, researchers wrote in the 2009 journal article. But there also are more complex mechanisms at play; for instance, increased platelet activity, coagulation and inflammation associated with stress and depression may also play a role in development of heart disease, studies show.

“Depression – just like stress – is physically hard on your system,” Theisen says.

The complicated web of connections between depression and heart disease leads to additional risk of illness and even death.

A 2005 American Heart Journal article cited research showing “serious consequences” for depression in heart disease patients.

For example, one study found that, after six months, heart attack patients who had been diagnosed with major depression during hospitalization “were (greater than) five times as likely to have died of cardiac causes than those without major depression.” After 18 months, mortality reached 20 percent in patients suffering from major depression – compared to just 3 percent in patients who weren’t depressed.

The American Heart Journal authors said treating depression in heart disease patients is “essential, not only because depression itself is a serious and debilitating condition, but also because treatment may reduce associated cardiac morbidity and mortality.”

So it’s important to be aware of, and watch for, signs of depression. While you might expect someone who’s had a cardiac event to be upset or sad in the short term, Theisen says longer-term mental health symptoms – such as having no hope or motivation; problems sleeping or excessive sleeping; a lack of appetite, or excessive appetite – may be warning signs.

More information on depression and symptoms is available from the National Institute of Mental Health.

Patients who may be suffering from depression should seek help from a medical provider. They may receive a referral to a psychiatrist or psychologist, or both, Theisen said.

“There are a lot of misconceptions about psychiatry or psychology. That can be an impediment for people to seek help,” Theisen says. “And there is still, in some circles, a stigma.”

“You don’t have to suffer,” he adds. “You don’t have to live like that.”

Based on his experience working with rehabilitating patients, Theisen also encourages counseling for patients who have suffered a significant health event like a heart attack.

“It might actually prevent development of depression,” Theisen says.

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