Wednesday, October 26, 2011

Anxiety & Depression 1

When I began to write this article, I was thinking of the aspects of depression and anxiety that occur after a heart attack, and also after any serious life-threatening illness.  But I found that depression and anxiety can also lead to a heart attack.

So let me begin with the after effects.  Depression and anxiety do occur with many people after a major illness.  The depression is because they recognize, often for the first time, their own vulnerabilities and that they might die sooner than they had expected.  The anxiety occurs because they are entering the unknown.  They don’t know what is going to happen to them, both medically and elsewhere in their life.  Will their job still be there ?  Will they still be able to participate in all the things that they were able to do in their lives, only yesterday ?  Although age is not a requirement for depression and anxiety, age can exacerbate the issue.

Your symptoms may vary from day to day. You might have some phantom chest pains, which will scare you.  There will some things that you just can’t do yet. Simple things, like walking very far.  And you will be learning the new limits of your body.  And you will hate it, because you haven’t had these limitations before.

So, you will be tired, you can’t drive for at least a month, maybe three.  You friends and family will sympathize but they can’t really feel it like you can.

And depression and anxiety can make you short-tempered and angry.

Why do I feel anxious?

As many as 30% of patients report feeling anxious or depressed after a heart attack or heart surgery. When you arrive home, you  are expecting to start feeling better. Your feelings of anxiety may be due to a mixture of reasons. You may be worried that you're going to have another heart attack, or you may have doubts about the success of your operation. These fears are a natural reaction to the stress of the event; they often resolve as time passes. It takes time for the implications of the condition to sink in, and the uncertainty of work prospects may worry you.  Your friends and family will likely not be able to understand why you feel anxious; they think you should be relieved to be alive and on the mend.  And on your intellectual level, you feel this too.  But on the emotional level, you still have these feelings and they can last for long time.

Is it normal to feel anxious after a heart attack or bypass surgery?

Anxiety is common after a heart attack or heart surgery; up to one third of heart patients experience anxiety. Anxiety levels are highest in the first 12 hours after a heart attack. Many studies have shown that anxiety is more common in women than men after a heart attack or bypass surgery. For most heart patients, levels of anxiety return to normal after hospital discharge. If you can't shake your concerns, you may have an anxiety disorder. About half of anxious heart patients still experience symptoms up to a year after their heart attack.

Here are the symptoms of anxiety as outlined by the U.S. National Institute of Mental Health:
  • Unable to relax or concentrate
  • Easily startled
  • Fatigue
  • Headaches
  • Muscle tension and muscle aches
  • Trembling or twitching
  • Irritability
  • Sweating or hot flashes
  • Feeling lightheaded or out of breath
  • Nauseous
  • Going to the bathroom frequently
  • Trouble falling or staying asleep

Am I depressed?

You may experience fatigue, tiredness, irritability, or flairups of temper.  And these can happen quickly and unexpectedly. These could be signs of depression. Soon days will be better than others.  You will be tired and need naps.  These are important for your depression and the physical rebuilding of your body.  But even having these can depress you.  But don’t fight it.  Some cardiologists recommend having a short nap each day.  These naps can cut your risk of reoccurrence by a large margin.

About one in five people suffer from major depression after a heart attack, bypass surgery or angioplasty.  Some degree of depression occurs in up to a third of all heart attack survivors.  And, women generally experience more depressive symptoms than men after a heart attack or bypass surgery.

Here are the symptoms of depression as outlined by the U.S. National Institute of Mental Health:
  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, waking up early, or oversleeping
  • Loss of appetite and weight loss, or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain 

Can depression affect my recovery?

Many studies have found that depression increases the risk of dying after a heart attack.  In women, depression appears to increase the risk of dying from a heart-related cause within the first year of a heart attack. The effects of depression can also last a long time; depression one month after surgery can be associated with the recurrence of chest pain up to 5 years later. If you're depressed, you may also be less likely to take your medicine or make the lifestyle changes prescribed by your healthcare provider.

What can I do?

As a survivor, you need to confront potential underlying fears and anxieties. You are encouraged to:
  • Be patient.  Anxiety and depression after a heart attack are usually  temporary.
  • Discuss feelings with your doctors, family and friends.
  • Keep a journal. Sometimes, writing about feelings can help a heart attack victim feel better.
  • Arrange for counseling if these persist for more than four weeks. .

Making friends and family aware of possible problems can help their understanding of your situation. It can also be reassuring for you and your family to know that problems are usually temporary.

You may like to join a cardiac support group as it can be useful to share your concerns with people who have been through the same experience. Contact your local heart association or your own doctor for direction
Rehabilitation programs are another excellent option. They provide information on healthy eating and managing risk factors for coronary heart disease; they also run exercise programs, and I will write about each of these in future posts.

Also available are counseling and stress relieving activities for people who have had heart attacks or heart surgery. You will usually be contacted by a rehabilitation nurse before you leave hospital. If you find it difficult to attend a rehabilitation program, you may be offered a self-help Heart Manual from your local hospital to use at home. It is important to discuss any problems with your doctor as he or she may be able to help you resolve your anxieties. If your anxiety or depression becomes severe, and there is no sign of improvement, you may need treatment from your doctor or a professional counselor or therapist

There may also be loss of libido or impotence for men, which may be due to anxiety or depression, the chest discomfort after surgery, or else due to certain medications such as beta-blockers or diuretics. If you think your medication may be affecting you in this way, ask your doctor about changing it. Your doctors are an excellent resource for you.  Don’t overlook this avenue.

Charles Spurgeon said it best: “Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength”.

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