Heart disease and depression often go hand-in-hand.

• You are more likely to feel sad or depressed after a heart attack or heart surgery, or when symptoms of heart disease change your life.
• People who are depressed are more likely to develop heart disease.

The good news is that treating depression may help improve both your mental and physical health.

Heart disease and depression are linked in a number of ways. Some symptoms of depression, such as lack of energy, can make it harder to take care of your health. People who are depressed may be more likely to:

• Drink alcohol, overeat, or smoke to deal with feelings of depression
• Not exercise
• Feel stress, which increases the risk for abnormal heart rhythms and high blood pressure.
• Not take their medicines correctly

All of these factors:

• Increase your risk of having a heart attack
• Increase your risk of dying after a heart attack
• Increases your risk of being readmitted to the hospital
• Slow down your recovery after a heart attack or heart surgery

It is pretty common to feel down or sad after having a heart attack or heart surgery. However, you should start to feel more positive as you recover.

If the sad feelings do not go away or more symptoms develop, do not feel ashamed. Instead, you should contact your health care provider. You may have depression that needs to be treated.

Other signs of depression include:

• Feeling irritable
• Having trouble concentrating or making decisions
• Feeling tired or not having energy
• Feeling hopeless or helpless
• Trouble sleeping, or sleeping too much
• A big change in appetite, often with weight gain or loss
• A loss of pleasure in activities you usually enjoy, including sex
• Feelings of worthlessness, self-hate, and guilt
• Repeated thoughts of death or suicide

Treatment for depression will depend on how severe it is.

There are two main types of treatments for depression:

• Talk therapy. Cognitive behavioral therapy (CBT) is a type of talk therapy commonly used to treat depression. It helps you change thinking patterns and behaviors that might add to your depression. Other types of therapy may also be helpful.
• Antidepressant medicines. There are many kinds of antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the two most common types of medicines used to treat depression. Your provider or therapist can help you find one that works for you.

If your depression is mild, talk therapy may be enough to help. If you have moderate to severe depression, your provider may suggest both talk therapy and medicine.

Depression can make it hard to feel like doing anything. But there are ways you can help yourself feel better. Here are a few tips:

• Move more. Regular exercise can help reduce depression. However, if you are recovering from heart problems, you should get your provider's OK before starting to exercise. Your provider may recommend joining a cardiac rehabilitation program. If cardiac rehab is not right for you, ask your provider to suggest other exercise programs.
• Take an active role in your health. Studies show that being involved in your recovery and overall health can help you feel more positive. This includes taking your medicines as directed and sticking to your diet plan.
• Reduce your stress. Spend time each day doing things you find relaxing, such as listening to music. Or consider meditation, tai chi, or other relaxation methods.
• Seek social support. Sharing your feelings and fears with people you trust can help you feel better. It can help you better handle stress and depression. Some studies show it may even help you live longer.
• Follow healthy habits. Get enough sleep and eat a healthy diet. Avoid alcohol, marijuana, and other recreational drugs.

Contact your provider if:

• You hear voices that are not there.
• You cry often without cause.
• Your depression has affected your ability to participate in your recovery, or your work, or family life for longer than 2 weeks.
• You have 3 or more symptoms of depression.
• You think one of your medicines may be making you feel depressed. Do not change or stop taking any medicines without talking to your provider.

If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Beach SR, Celano CM, Huffman JC, Januzi JL, Stern TA. The psychiatric management of patients with cardiac disease. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF, eds. Massachusetts General Hospital Handbook of General Hospital Psychiatry. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 26.

Freedland KE, Carney RM, Lenze EJ, Rich MW. Psychiatric and psychosocial aspects of cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 99.