Heart Disease and Depression: How Your Heart and Mood Are Connected

Finn: The Centers for Disease Control and Prevention says mental health disorders can develop after cardiac events. A cardiac event means something like a heart attack. Those disorders include depression, anxiety and post-traumatic stress disorder, which you may hear called P T S D.

Claire: I wouldn't have guessed that last one. Why would a heart attack lead to something like that?

Claire: Thanks for joining us. You're listening to Between Visits, sponsored by Hope Health Network, a network of medical practices serving South Carolina. We dig into the medical and mental health topics that matter most to patients and the public.

Claire: I'm Claire, and this is episode 10. I'm going to quickly play our disclaimers, and then we'll get started!

Recorded disclaimer: This show is for entertainment, education and general information only. It's not medical advice, and listening doesn't make you a patient. Our hosts and guests are not real people, medical doctors or healthcare providers. We do our best, but we can be wrong, and our content can have errors and omissions. Talk with a licensed medical provider in your state before you make any decisions about your health or medical care.

Claire: Joining me today is Finn, from our digital entertainment team. Today's topic is an important one: Heart Disease and Depression: How Your Heart and Mood Are Connected.

Claire: This can be a heavy subject. If it ever starts to feel like too much, at any point today, it's okay to step away. And help is always just a call away, any time, day or night. In an emergency, call 911. In a crisis, call or text 988.

Claire: Okay, Finn. Thanks for being here today.

Finn: Thanks, Claire. I'm glad we're talking about this.

Claire: Me too, Finn.

Claire: Let's dig into your heart and your mood. I think a lot of people see those as two separate things. One is for the heart doctor, and the other is for a counselor.

Finn: Many people do see it that way. But the two are more connected than many people realize. Heart disease can bring on depression or anxiety. And long-lasting depression, anxiety or stress can affect the heart.

Claire: So it goes both ways.

Finn: It does. And that matters for your care, because looking after one can be part of looking after the other.

Claire: Let's start with the first direction. Say someone has a heart attack. They get through it, they get home, and then they just don't feel like themselves. Is that normal?

Finn: After a heart attack, a new heart diagnosis or a hospital stay, it's common to feel shaken for a while. A lot can change at once.

Claire: And when is it more than just being shaken up?

Finn: The Centers for Disease Control and Prevention says mental health disorders can develop after cardiac events. A cardiac event means something like a heart attack. Those disorders include depression, anxiety and post-traumatic stress disorder, which you may hear called P T S D.

Claire: I wouldn't have guessed that last one. Why would a heart attack lead to something like that?

Finn: The same agency points to a few things. Pain. Fear of death or disability. And money worries after the event.

Claire: Well, sure. That's a lot to carry. You're hurting, you're scared, and you're thinking about the bills.

Finn: Right. Any of those can play a part. So if your mood hasn't been the same, that isn't a weakness. And these conditions are treatable.

Claire: Okay. Now the other direction. Can feeling down really do something to your heart? I have to push back a little, because that sounds like one of those things people just say.

Finn: It's fair to ask. The Centers for Disease Control and Prevention says a large and growing body of research shows that mental health is associated with risk factors for heart disease. A risk factor is something that raises your chance of getting a disease.

Claire: So it's not just a saying. There's research behind it.

Finn: Yes. The National Institute of Mental Health also notes that depression may raise the risk of other conditions, including heart disease. And people who have a long-term disease and depression tend to have more severe symptoms of both.

Claire: So each one can make the other one harder.

Finn: That's a fair way to put it.

Claire: Walk me through the body part of this. What does stress actually do if it goes on and on?

Finn: The Centers for Disease Control and Prevention describes a few changes with long-term depression, anxiety, stress and P T S D. The heart can react more strongly, with a higher heart rate and higher blood pressure.

Claire: So heart rate up, blood pressure up. What else?

Finn: Blood flow to the heart can drop. And levels of cortisol can rise. Cortisol is a stress hormone. A hormone is a chemical messenger your body makes.

Claire: And we're talking about the long haul here, right? Not one bad day at work.

Finn: Right, this is about long-term problems. Over time, that agency says, these effects can lead to calcium buildup in the arteries, metabolic disease and heart disease.

Claire: Okay, slow down for me. Calcium buildup in the arteries. Metabolic disease. What does that mean in regular words?

Finn: Arteries are the tubes that carry blood away from your heart. Calcium buildup means a hard material collects inside them. And metabolic disease is a problem with how your body uses food for energy.

Claire: That's not something I'd connect with being stressed out. What about everyday habits? Because when I'm feeling low, I'm sure not going out for a walk.

Finn: That's part of it too. Mood affects daily habits. The Centers for Disease Control and Prevention notes that mental health disorders may increase the chance of smoking, being inactive or not taking prescribed medicines.

Claire: Not taking your medicines. That one worries me, if those are your heart medicines.

Finn: All of those matter for heart health. If you've been missing doses, tell your provider. It's worth saying out loud.

Claire: And you might not even see it as a mood thing. You might just be mad at yourself for slipping.

Finn: It can feel that way. That's one more reason to bring it up.

Claire: So how does someone know when to say something? Everybody has a bad week now and then.

Finn: Here's a simple guide. Tell your provider if a sad, anxious or empty mood lasts 2 weeks or more. The same goes for losing interest in things you used to enjoy, or trouble sleeping.

Claire: Two weeks. That's easy to remember.

Finn: Yes. The National Institute of Mental Health lists these among the signs of depression.

Claire: And what if it's more serious than that? What if someone is in a really dark place?

Finn: If you are having thoughts of suicide, call or text 988, any time. That's the 988 Suicide and Crisis Lifeline. It's free and it's confidential. If you are in immediate danger, call 911.

Claire: And that's for someone you're worried about, too?

Finn: Yes. If you or someone you know is struggling, call or text 988.

Claire: Thank you for saying that. So let's say I speak up. Then what? Can this be treated, or am I just adding one more problem to my pile?

Finn: Depression and anxiety are treatable. Treatment can include talk therapy, medication or both. Your provider can help you choose what fits alongside your heart medicines.

Claire: That's a good point. I'd want it to work with what I already take.

Finn: Right. The right choice depends on your diagnoses, your other health conditions and your current medicines.

Claire: Should heart care be asking about this anyway? Or is it on me to bring it up?

Finn: The Centers for Disease Control and Prevention recommends building mental health screening and treatment into care after a major heart event, and into care for long-term disease. Screening just means checking for a problem. It also says addressing mental health early can reduce heart disease risk.

Claire: So I shouldn't wait for someone to ask me.

Finn: That's right. That agency encourages people to talk with their health care professionals about how their mental health and their heart health connect.

Claire: Let's talk about how this gets done. There's a service called Behavioral Health Integration. That's a mouthful.

Finn: It is. You may hear it called B H I. It's a Medicare service that brings mental health care into your primary care. Primary care is your regular care, the office you go to for most things.

Claire: So I don't have to keep two separate worlds going.

Finn: That's the idea. Medicare covers two kinds, called psychiatric Collaborative Care and general B H I. Hope offers general B H I.

Claire: And what do I actually get with that?

Finn: The Centers for Medicare and Medicaid Services describes three things. Your care team checks and keeps track of how you are doing. They adjust the care plan if you are not improving enough. And you get a continuous relationship with an appointed member of your care team.

Claire: Regular words again. So there's one person who stays with me and knows what's going on?

Finn: Pretty much. At Hope, that's a care coordinator who works closely with your provider. That way, your mood and your heart health are part of the same plan.

Claire: The same plan. I like that. Okay, people are going to ask. What does it cost?

Finn: Fair question. Medicare Part B may pay for B H I services if you have a behavioral health condition such as depression or anxiety, and you are eligible. After the Part B deductible, you generally pay 20 percent of the Medicare-approved amount.

Claire: And the deductible is the part you pay first, before the plan starts paying.

Finn: Right. Medicare Advantage plans must cover everything Original Medicare covers, but costs and rules vary. So check with your plan.

Claire: And what if I start and decide it's not for me? Am I stuck?

Finn: No. Before B H I begins, you are asked for your consent, which means your okay. And you can stop at any time.

Claire: That's good to hear. If someone's listening and their mood hasn't been right since a heart scare, they may not know how to bring it up. What could they say?

Finn: Here's a simple one. Since my heart diagnosis, my mood has not been the same. Could we look at my mental health as part of my care plan?

Claire: That's nice and plain. You could write that down and take it with you.

Finn: You could. And you can ask whether Behavioral Health Integration is right for you at the same time.

Claire: Okay, before we wrap up. If people only remember a few things from today, what should they be?

Finn: First, your heart and your mood affect each other. It goes both ways.

Claire: Okay. What else?

Finn: Second, if a low mood, lost interest or trouble sleeping lasts 2 weeks or more, tell your provider. These conditions are treatable.

Claire: And one more?

Finn: If you are having thoughts of suicide, call or text 988, any time. And if you are in immediate danger, call 911.

Claire: That's really helpful. Thank you for walking us through this.

Finn: Thanks for having me, Claire. I hope it helps someone.

Claire: This episode is sponsored by Hope Health Network. Its member practices all have providers experienced in managing depression with heart disease, or can refer you to a network provider who is. Hope Health Network medical practices provide evidence-based medical care and include Hope Integrative Medicine, Hope Medical Associates, Hope Behavioral Medicine and Hope Addiction Medicine. To learn more, go to Hope Health Network dot com. That website, along with appointment links for all four practices, is in the description of this episode.

Claire: One last reminder. In an emergency, call 911. In a crisis, call or text 988.

Claire: This podcast is a production of Hope Health Network Media.

Claire: You've been listening to episode 10 of Between Visits, Heart Disease and Depression: How Your Heart and Mood Are Connected. Thanks for hanging out with us. See you next time!