Depression in bypass patients: non-drug treatments work

It is a known fact -surgery may mend the body but it may also depress the mind. This is especially true with heart surgery. It is estimated that 1 in every 5 patients who underwent coronary artery bypass graft (CABG) surgery suffer from major depression. Many others may suffer from milder forms of depression. However, it is also a known fact that negative feelings are bad for the heart, thus creating a vicious cycle that delays recovery and reduces quality of life.

According to researchers at the Washington University School of Medicine

“Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death].”

Thus, the researchers conducted a study which involved 123 CABG patients who developed depressive symptoms within one year of surgery. The patients were randomly assigned to three groups, namely:

• 40 patients were assigned to standard care
• 41 patients received 12 weeks of cognitive behavior therapy which consisted of 50- to 60-minute sessions with a psychologist or social worker involved identifying problems and developing cognitive techniques for overcoming them, including challenging distressing automatic thoughts and changing dysfunctional attitudes.
• 42 patients underwent 12 weeks of supportive stress management, wherein the received counselling from social worker or psychologist coping with stressful life events.

The depressive symptoms were monitored before the therapies, at 3, 6, and 9 months.

The study results show that the two non-drug treatments helped in resolving the depressive symptoms better compared to standard care.

The percentage of patients who experienced depression remission are:

• 71% of patients in the cognitive behavior therapy group
• 57% of patients in the supportive stress management group
• 33% of patients in the usual care group

Cognitive behavior therapy seems to be the best strategy, not only against cardiac surgery-related depression but also secondary psychological outcomes, such as anxiety, hopelessness, and perceived stress. Supportive stress management also showed some benefits against depression, “but it had smaller and less durable effects than cognitive behavior therapy.” In comparison, current standard care is not seem to be that effective in resolving depressive symptoms among CABG patients. A previous study has shown that although the medical needs of heart patients are usually met by standard care, there are non-medical needs that usually go unmet but are nevertheless just as important in clinical outcomes.

In fact, the American Heart Association (AHA) issued a science advisory this year recommending routine screening for depression in cardiac patients.

               

Depressed? Check your blood pressure!

The link between depression and cardiovascular health is well-known although the mechanism behind the relationship is not well-understood.

A study by Dutch researchers may just give us an idea of the complexity of that link. For one thing, contrary to the common perception that depression can lead to hypertension, depression, is, in fact, associated with low blood pressure. However, medications against depression - the so-called anti-depressants can increase blood pressure. In particular, tricyclic antidepressants (TCAs) can increase the risk for hypertension.

According lead author Carmilla Licht

“Doctors should at least be aware of a potential blood-pressure rise that could be linked to TCA use, especially for patients with cardiovascular disease or high blood pressure or others who are at risk for hypertension…They may consider meticulously monitoring these patients’ blood pressure when they prescribe one of these antidepressants or consider prescribing another antidepressant medication.”

The results of the study are somewhat controversial because they contradict the current “depression-hypertension theory.”

The study was part of the Netherlands Study of Depression and Anxiety, and followed up 2618 participants aged 18 to 65 years old. The study participants were divided into 3 groups:

• Control group without history of anxiety or depression
• Patient group with a major depressive disorder (MDD) but not on antidepressants
• Patients with MDD and on antidepressants

Patients were monitored for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and distinction was made between different types of antidepressants, e.g. selective serotonin-reuptake inhibitors (SSRIs) vs tricyclic antidepressants (TCAs).

The study also observed that a typical patient with psychiatric disorder “were a little older, more likely to be female, less educated, less physically active, smoked more, and had a higher body-mass index and more diseases.”

The study results showed that compared with health controls, MDD patients have significantly lower blood pressure. However, MDD patients on TCA had significant higher blood pressure. The use of SSRIs doesn’t seem to be associated with blood pressure measurements.

So the next question is

Is it the depression that lowers the blood pressure or is it the low blood pressure that causes the depression?

The authors speculate that three things might influence the depression-low blood pressure link.

• Use of anti-hypertensive drugs
• Common causes of depression and low blood pressure, e.g. fluctuations in metabolites, hormones or neurotransmitters
• Low blood pressure can cause depressive symptoms, e.g. fatigue, dizziness, low tolerance to cold temperatures, and concentration problems.

While depression is associated with low blood pressure, the study shows that anxiety is linked to high blood pressure. This, the authors say, might be due to continuous stress associated with anxiety.

Photo credit: stock.xchng

               

Is there sex life after a heart attack?

Resource Post for March

Now, more than ever, patients with heart disease are much longer but unfortunately their quality of life is not necessarily better. The latest medical advances save people’s lives but the care in the life after - after heart surgery, after discharge, rehabilitation, etc. - sometimes fall short.

Depression is a common aftermath of heart surgery and other cardiac events. A previous study showed that depression is commonly reported among young people aged 18 to 49 years old. They are tended to be female, of African American or Hispanic ethnicity.

I imagine that young people would be depressed since these years are the most active and productive years of their lives. Young women of reproductive age would be worried about their ability to raise their families or even able to start a family at all.

Depression has also been reported among the elderly but not to the extent observed in young people.

It is to be expected that one main cause of depression among young cardiac patients is sex, rather lack thereof. Sexual satisfaction is a part of life. And for the sexually active, the question of whether sex after a heart attack is still possible is another big factor that may contribute to depression and overall poor quality of life. Unfortunately, Hollywood has erroneously portrayed in films the horrors of having a heart attack in the act of sexual intercourse, scenes which can dampen the spirits of both the heart patient and his/her partner. A report presented at the European Cardiology Society last year stated that heart patients

…may have concerns about resuming sexual activity, feelings of sexual inadequacy, changes in sexual interest or changes in patterns of sexual activity…[They] are worried about chest symptoms during intercourse or even an acute ischemic event during sex. Many lack information about returning to sexual activity.

Researchers looked at the sexual satisfaction of 35 female with either non-STEMI or unstable angina and reported the following results::

• 49% resumed sexual activity within 12 weeks of hospital discharge.
• 35% reported being “sexually unsatisfied
• 41% were “mostly dissatisfied
• 24% were “somewhat dissatisfied
• 83% reported sexual desire to be lower compared to desire before the cardiac event.

But is there really room for sexual activity in a heart patient’s life?

Apparently, the answer is a resounding “Yes” but with some caveats.

According to this WedMD article “it is important to remember that sex is a workout. So doctors typically tell patients to abstain from sex after heart disease until they can withstand the cardiac workout.”

This means that people who are sedentary may have to abstain from postcardiac event sex until they are back on their feet and have passed their stress tests. What the doctors are saying is that if a patient can handle climbing the stairs or light jogging around the block, then he or she is ready to resume sexual activity.

But sometimes fear and the uncertainty can interfere even if the body is physically ready. Here are some tips that you may try to counteract this problem:

Do not blame yourself. It is not your fault and it is alright to feel frustrated. So stop blaming yourself. Erectile dysfunction is linked to heart disease. Some cardiac medications can interefere with sexual drive and performance. Nothing you can do or have done could change this.  However, you have to do something about it and the first step is talk about it.

Talk to your doctor. I know that this topic maybe embarrassing for some people, depending on personality as well as cultural and religious backgrounds. However, your doctor is the best person who can tell you whether you are ready or not and what it takes to get you back into shape. Your doctor can give you all the information you need and can even refer you another professional if necessary.

Avoid self-medication. Be careful about performance enhancing and erectile dysfunction drugs. You see them advertised on the Internet all the time and your email Inbox is probably flooded by sales pitches on cheap Viagra and penis enlargement pills. However, these drugs may not be what they seem. They may be disguised in the form of dietary supplements, tea, herbal remedy, or energy drinks. Some of these substances can increase heart rates while others can interact with the other drugs you may already be taking. So before you resort to self-medication, talk to your doctor first. He would know which drug would be most appropriate and safest for you.

Talk to your partner. Be open about your fears and worries. For all you know, he or she also has some doubts and worries about the situation. Take him or her when you go talk to your doctor.

Give yourself time. Sex doesn’t have to start at day one. It doesn’t have to be perfect the first time around after surgery. Take your time. Give your body and mind the time to heal and recover.

Go for counselling. Professional help may be necessary and your doctor can refer you to a psychologists or a sex counsellor. These health professionals may also prescribe drugs, devices, as well as therapies that can help.

Live a healthy lifestyle. You can’t live on sex alone. And your body should be fit to perform normal daily tasks, including sex. That is why you shouldn’t forget to maintain a healthy lifestyle which includes physical activity and the proper diet. Remember: a healthy and active sex life depends on an active and healthy lifestyle.

 

 

 

 

Photo credits: stock.xchng

               

Shaking off the winter blues (SAD!)

The groundhog was right earlier this month - winter in the northern hemisphere is taking longer than usual this year. And the winter blues will take longer to shake off as well. But winter blues is not just a state of mind. It’s for real and in doctor speak it’s called seasonal affective disorder (SAD - what an apt abbreviation!), a psychiatric condition characterized by depressive symptoms during the long, dark, winter months. SAD is said to affect about 2 to 5% of Americans. The incidence is higher as one goes north, where the winters are colder and the daylight hours are less. No wonder the suicide rates are high in winter time in these regions.

Other symptoms include:

• Mood disturbances
• Chronic fatigue and need for more sleep
• Cravings for carbs, leading to increase in weight

Health experts at the University of California at Davis give us some tips on how to survive the winter blues or SAD.

Go outside, go for the light.

A major characteristic of SAD is that it usually goes away with the coming of spring the sun shines more and the days get longer. But in the midst of the winter, we have to find our own source of light, be it normal or artificial.

UC Davis experts recommends a daily walk outside, preferable at midday, to get the most of whatever daily is available. Another way is to adjust our sleeping patterns by going to bed early and waking up early to take advantage of the short daytime. This is one of the reasons why we have daylight savings time.

In Switzerland where I am residing, the gloominess of winter is worsened by the fog and low clouds that are produced by the big lakes in the lowlands even if the sun can be blinding up in the mountains. To help people escape the blues, they are given daily tips as which is the closest hilltop or mountain to go to see the sun. You will even see these tips on the train schedule boards. Great service, eh?

Sun exposure also has the additional benefit of getting Vitamin D!

Use artificial light if you must.

Now, while sunlight may be the best cure for SAD, it may not be available all the time. Think of all those living in the winter darkness up north. Well the UC Davis experts recommend artificial light therapy.

The standard medical treatment for SAD is a TV-sized light box, containing fluorescent bulbs behind a protective filter. These boxes, which cost in the range of $200 to $500 (and are sometimes available to rent), are covered by an increasing number of insurance companies. They emit 2,500 to 10,000 lux (a term used to quantify brightness), which is about equivalent to the outdoor light of dawn or dusk. Illumination in homes and offices is about 500 lux. Treatment for SAD typically involves daily sessions in front of a light box for a period of 15 minutes to 2 hours.

Counselling and medications

Artificial light therapy is said to be work better and faster than drugs. But in cases where light alone doesn’t help, this can be combined with anti-depressants and counselling. Selective serotonin reuptake inhibitors (SSRIs) such as Prozac seem to work best.

Think positive!

This one is from me. Isn’t it great to know that even if we are sad with SAD, the treatment may just be right outside our front door, and relief is just a couple of weeks away? Spring, here I come!

               

How to keep your heart healthy in a recession

Recession then depression. It can really break your heart. It has happened before and it’s happening again. People are down and depressed and some are even committing suicide. But recession and depression can also have some long-term effects on our health that may persist long after the financial markets have recovered. Our cardiovascular health is especially at stake as we encounter stress, mental as well as physical everyday. But in tough times like this, we should really take care of ourselves and keep in mind that real wealth is good health. Here are some tips on how to take care of your heart and health in times of recession.

Eat properly. Make your health and nutrition your number one priority. Cut down on expenses, if you must, but don’t cut down on the right food. You can make some adjustments though. You might go for the cheaper run-of-the-mill vegetables rather than the more expensive organic ones. You might opt for the locally produced fruit over the exotic imported types you used to prefer.

Take your medications. Medication is another of the things that we cannot do without even during recessions. I am not referring to vitamins and dietary supplements but the medications needed to manage chronic conditions such as insulin, statins, or beta-blockers.

Keep the stress low. With bad news coming from all sides, it is difficult not to get stressed. And stressors play a major role in cardiovascular health. Don’t take is personally. It’s only money. There are many stress management strategies that you can do and some are on this list (exercise, going out). Ask your health care provider for stress management advice.

Do exercise. The economy maybe standing still but doesn’t mean that you should. You can cut down on fitness center and golf club membership fees but not on exercise. And don’t say that they all go together in one package because they don’t. There are cheap forms of exercise such as cycling, running, or simply walking to work, to shop, etc. And hey, in the process, you reduce stress, improve your cardiovascular health, lower your CO₂ emission and help curb air pollution that is bad for your heart.

Avoid alcohol. Burying your sorrows in alcoholic drinks is not the best strategy in these hard times. Alcohol is high in calories and if taken in large quantities, can damage the heart and the liver. Drinking should only be done in moderation with meals and only when you are feeling relaxed. Drinking when feeling depressed is simply asking for trouble.

Go out. Don’t mope inside the house. Go out for a walk, if only around the block and enjoy the sunshine and fresh air. The combination of recession plus cold winter weather can result in a disaster that can drive us crazy. Go out with your friends and family once in awhile. You might have to downgrade to a cheaper restaurant but who cares? Good company counts.

Smell the flowers. Maybe this is your chance to slow down and check your priorities in life. Maybe this is your chance to pause and smell the flowers.

Here are some other survival tips you might want to check out:

• Keeping fit it a sick economy
• 10 Ways to Protect Your Heart From the Tolls of Recession

 

Photo credit: stock.xchng

               

Expert recommendations:heart patients should be screened for depression

Background

Time and time again, studies have shown that many patients become depressed after suffering from major cardiac events. This occurs even after successful surgery and interventions. The reasons for this depression are many and may differ depending on the age of the patients (see previous post).

With this knowledge in mind, the American Heart Association (AHA) issued a new science advisory endorsed by the American Psychiatric Association which recommends that primary health care physicians should routinely screen their cardiac patients for signs of clinical depression. This would include referring suspected cases to mental health specialists for assessment, monitoring, and therapy.

Depression in heart patients

According to Dr Viola Vaccarino

“Despite a long-standing popular belief that stress and emotions affect the cardiovascular system, it was not until the mid-1980s that the first studies linking depression to higher mortality after a myocardial infarction (MI) began to appear in the medical literature. Since then, scientific interest in the link between depression and heart disease has grown steadily over time, with an increasing number of research studies addressing depression as a prognostic factor in cardiac patients. There is now a sufficient consensus that depression is a risk factor for coronary heart disease (CHD), as well as an important prognostic factor in cardiac patients. It is also recognized that depression is a growing global problem. By 2030, depression is projected to be the second leading cause of disability worldwide (after HIV/AIDS) and the number one cause of disability in high-income countries.“

Screening methods

The recommended assessment for depression in cardiac patients is fast and easy. The patients only have to initially answer 2 questions. Longers questionnaires may be needed when further assessment is deemed necessary.

Experts believe that the recommended questionnaires

“are validated tools and an efficient, evidence-based way of finding possible cases and referring them on for further assessment and treatment.”

However, a big problem would be how the patients would accept the recommendations for screening and the diagnosis of depression. People with heart disease would not necessarily be happy (and they are already unhappy) when they hear they have another clinical problem to face.

Treatments

The AHA advisory recommends pharmacological treatment of depression. As first line of treatment, the selective serotonin reuptake inhibitors (SSRIs) sertraline and citalopram are recommended. Furthermore, AHA cautions that some antidepressant drugs may have some cardiotoxic effects that can worsen existing cardiovascular conditions.

For those who cannot tolerate antidepressant medications or prefer nonpharmacological treatments, cognitive behavior therapy is recommended. A combination of both psychotherapy and medications may also work for some patients. The important thing is to find the right therapeutic approach for patients.

               

It’s not the weather, it’s your lifestyle

Winter time is a difficult time for many people. It’s cold, dark, and gloomy. No wonder winter is associated with high incidence of depression.

Currently available data indicate that depressed individuals have a 50% higher risk for cardiovascular disease than those without psychological problems. Guidelines issued by American Heart Association (AHA) and endorsed by the American Psychiatric Association recommend that cardiac patients be routinely screened for depression. In addition, treatment of depression is commonly addressed during cardiac rehabilitation. In related previous posts, depression among heart patients were shown to be best tackled with a combination of psychotherapy and physical exercise.

But - we cannot blame the weather for everything. Researchers at the University of College London report that the wrong lifestyle leads to psychological distress, which in turn result in increased risk for cardiovascular disorders. In addition, the findings of the current study “suggest that treating psychological stress on its own might not be the best approach to reducing the risk of cardiovascular disease.”

The study used data from the Scottish Health Survey (SHS) which followed up 6576 adults aged 30 years and above fo7 seven years (on the average). The researchers measured psychological distress as well as behavioral and pathophysiological risk factors. The measurements were based on the General Health Questionnaire (GHQ-12), an assessment tool which basically looked at general levels of happiness, depression and anxiety, and sleep disturbances.

The results showed that

“…behavioral factors, including smoking, physical activity, and alcohol consumption, accounted for 65% of the relationship between psychological distress and cardiovascular disease risk. An additional 19% of the association was explained by pathophysiological risk factors, such as hypertension and C-reactive protein (CRP).”

The role of smoking and physical activity seems especially significant. People who were stressed of psychologically distressed tended to be smokers who little or no exercise at all. “These two factors alone explain well over 50% of the association between distress and cardiovascular risk.” Surprisingly, alcohol explained only a small part of the psychological distress - cardiovascular risk link.

The study results indicate the association between psychological distress and cardiovascular risk can be largely explained by behaviour and lifestyle factors, in this case, cigarette smoking and physical activity.

If your goal is to treat mental illness for the purposes of reducing cardiovascular risk, you need to take a fairly broad approach and not just look at the psychological components,” lead investigator Dr Mark Hamer (University College London, UK) told heartwire. “You need to also look at the behavioral risk factors as well, with a particular emphasis on physical activity and smoking cessation.”

Now that we are about to enter the New Year, maybe it’s time to reflect on our lifestyle. Is there anything we can change for the better? For better mental and physical health?

               

Experts recommend screening for depression in cardiac patients

Background

Time and time again, studies have shown that many patients become depressed after suffering from major cardiac events. This occurs even after successful surgery and interventions. The reasons for this depression are many and may differ depending on the age of the patients (see previous post).

With this knowledge in mind, the American Heart Association (AHA) issued a new science advisory endorsed by the American Psychiatric Association which recommends that primary health care physicians should routinely screen their cardiac patients for signs of clinical depression. This would include referring suspected cases to mental health specialists for assessment, monitoring, and therapy.

Depression in heart patients

According to Dr Viola Vaccarino

“Despite a long-standing popular belief that stress and emotions affect the cardiovascular system, it was not until the mid-1980s that the first studies linking depression to higher mortality after a myocardial infarction (MI) began to appear in the medical literature. Since then, scientific interest in the link between depression and heart disease has grown steadily over time, with an increasing number of research studies addressing depression as a prognostic factor in cardiac patients. There is now a sufficient consensus that depression is a risk factor for coronary heart disease (CHD), as well as an important prognostic factor in cardiac patients. It is also recognized that depression is a growing global problem. By 2030, depression is projected to be the second leading cause of disability worldwide (after HIV/AIDS) and the number one cause of disability in high-income countries.“

Screening methods

The recommended assessment for depression in cardiac patients is fast and easy. The patients only have to initially answer 2 questions. Longers questionnaires may be needed when further assessment is deemed necessary.

Experts believe that the recommended questionnaires

“are validated tools and an efficient, evidence-based way of finding possible cases and referring them on for further assessment and treatment.”

However, a big problem would be how the patients would accept the recommendations for screening and the diagnosis of depression. People with heart disease would not necessarily be happy (and they are already unhappy) when they hear they have another clinical problem to face.

Treatments

The AHA advisory recommends pharmacological treatment of depression. As first line of treatment, the selective serotonin reuptake inhibitors (SSRIs) sertraline and citalopram are recommended. Furthermore, AHA cautions that some antidepressant drugs may have some cardiotoxic effects that can worsen existing cardiovascular conditions.

For those who cannot tolerate antidepressant medications or prefer nonpharmacological treatments, cognitive behavior therapy is recommended. A combination of both psychotherapy and medications may also work for some patients. The important thing is to find the right therapeutic approach for patients.

Coming soon: resource post alternative ways of fighting depression

               

Quality of life after a heart attack

Because of advances in medical science, prognosis for coronary heart patients is now better than ever. Better treatment, better survival rates and better life expectancy.

However, though these patients live longer, they are not necessary happier. Many suffer from postoperative depression and fear of death.

Quality of life

American researchers looked into the quality of life of cardiac patients, which is a strong indicator of the effectiveness of treatment and long-term mortality, as well as the socioeconomic impact of disease.

Quality of life measurements

include physical functioning, psychological functioning, social functioning, overall life satisfaction, and perceptions of health status, can be used to measure effectiveness of treatment and predict the long-term mortality after a cardiac event.

Young people

Those most likely to suffer for poorer quality are young people aged 18 to 49 years old, female, and black or Hispanic. The loss of productivity and the prospect of death place a big burden on young people with coronary heart disease.

Elderly people

These concerns may not be as strong in older patients but they also exist. A Swedish study observed that elderly patients (mean age = 70 years old) with heart failure exhibit high levels of anxiety or depression that is correlated to fear of death. Although many accept as a natural relief from suffering, there are others who are afraid of pain, disability and loss of dignity.

Sexual satisfaction

Researchers also looked sexual satisfaction as a measure of quality of life. It is very often that the patients who have suffered from cardiac events experience problems with their sex life after discharge.

They may have concerns about resuming sexual activity, feelings of sexual inadequacy, changes in sexual interest or changes in patterns of sexual activity…[They] are worried about chest symptoms during intercourse or even an acute ischemic event during sex. Many lack information about returning to sexual activity.

In a 2007 study, researchers looked at the sexual activity of 35 female cardiac patients, with the following results:

• 49% resumed sexual activity within 12 weeks of hospital discharge.
• 35% reported being unsatisfied sexually, ranging from “mostly dissatisfied (41%)” to “somewhat dissatisfied (24%)”.
• 83% reported sexual desire to be lower compared to desire before the cardiac event.

Improving quality of life

There are many ways to improve the quality of life of cardiac patients.

• Dancing, for example, has been shown to be more effective than usual rehab programmes and seems to give patient extra zest for life.
• Physical exercise combined with pscyhological therapy also seems to work better than traditional therapies.
• Adjunct and alternative therapies such as laughter yoga seem to show positive effects.

In subsequent posts, I will discuss these therapies more in detail.

Photo credit: stock.xchng

               

Elder Suicide-Know the Warning Signs

Carol O’Dell, Caring.com’s Family Advisor and author of the memoir Mothering Mother, wrote a fantastic piece about one of those frightening topics we’d all rather not think about: elder suicide. But the fact that seniors have the highest suicide rates of any age group is one that we simply can’t afford to ignore.

Why are older people at such high risk for suicide? Depression is the biggest culprit, and it’s a condition that often goes undiagnosed in seniors. Some other factors that lead to suicide include debilitating illness, chronic pain, financial difficulties, isolation, and loss of a loved one or pet.

What can you do if you think your parent or loved one might be depressed or at risk for suicide? One of the most important things is to know the warning signs of suicide:

• Talking or reading about death and suicide
• Making statements of hopelessness or suicide threats
• Not sleeping enough or sleeping all the time
• Failing to take care of self or follow medical advice
• Stockpiling medications
• Becoming suddenly interested in firearms
• Increasing use of alcohol or prescription drugs
• Withdrawing socially
• Rushing to complete or revise a will
• Saying good-bye to family and friends

If your parent or someone you know is depressed or at risk, you can help by reaching out to that person. It’s not easy to broach the subject, but knowing you’re there to listen and help may make all the difference to someone contemplating suicide. “Your goal is to prevent a tragedy,” writes O’Dell. “Speak up — this is worth fighting for.”

This article was “reprinted” from www.caring.com (Elder Suicide: Know the Warning Signs)

PLEASE read Carol O’Dell’s entire article, Is Your Loved One (or Spouse) Considering Suicide-Know the Warning Signs. It’s a well written, interesting and informative article.

               

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