The Link Between Depression and Heart Attacks Is Real: This Is Why Cardiologists Must Screen Patients

Depressed man sitting on a rock alone | Depression & Heart attack is related related

According to the CDC, approximately 735,000 Americans have a heart attack each year. In 525,000 of these cases, it is the person’s first heart attack. For heart attack survivors, the rest of their lives are all too commonly associated with medical procedures. Perhaps they need their arteries unblocked or surgeons must open their blood vessels in emergency procedures.

Even after leaving the hospital, heart attack survivors must take a plethora of prescription drugs to keep their blood pressure and cholesterol levels under control. It’s easy to look at this scenario and only consider the physical toll. However, the severe mental strain endured by heart attack survivors often comes closest to claiming their lives.

Heart Attacks and Depression

In many ways, it seems obvious that heart attack survivors suffer from depression, but for a long time, we didn’t spot the link. According to the American Heart Association (ACA), approximately 10% of Americans over the age of 18 suffer from depression. Symptoms of depression are three times more common in survivors of heart attacks than in the general population.

Further statistics emphasize the point, as one-third of stroke survivors and half the number of people who undergo heart bypass surgery show signs of depression. Furthermore, depression is the strongest predictor of death in patients diagnosed with coronary heart disease in the decade after the initial diagnosis. People with coronary heart disease and depression symptoms are twice as likely to die in the next 10 years as individuals with heart disease but no symptoms of depression.

A Tricky Diagnosis

Many factors possibly explain why patients with depression carry a greater risk of heart disease. According to Doctor Milena A. Gebska of the University of Iowa, there is a two-way relationship between depression and heart attacks.

Depression is an independent risk factor for cardiac events in patients without a known cause of heart disease. In addition, patients with known heart disease, especially those that suffer a heart attack, carry an increased risk of developing depression symptoms. The problem is that physicians find it difficult to determine whether a case of heart disease leads to a patient’s first depression diagnosis. It is possible that the patient had undiagnosed depression symptoms before the adverse cardiac event.

The complex relationship between depression and heart attacks goes further. Effects of depression include failure to exercise and eat properly and engaging in harmful activities such as smoking and alcohol abuse. All of the above are well-established risk factors for heart disease. Insomnia is another risk factor for heart attacks, and it is another common symptom of depression.

If you suffered a heart attack and had depression, your behavior can make your plight even worse. For example, you may not comply with your doctor’s orders concerning taking your medication, or fail to meet the other behavioral demands associated with heart attack recovery.

Depression possibly has a negative physiological impact on your heart rhythm, stress hormone levels, and blood pressure. This would help explain why people recovering from heart attacks who also have depression are twice as likely to die as heart attack survivors without depression are.

According to Dr. Lauren Osborne of Johns Hopkins University, inflammation potentially plays an important role in the connection. She claimed that when doctors gave patients medicines that tended to increase the levels of inflammatory molecules in their blood, their depression symptoms intensified.

A Shocking Discovery

Researchers at Salt Lake City’s Intermountain Medical Center Heart Institute performed a detailed study on the link between depression and premature death in heart attack survivors. The team analyzed the health records of approximately 25,000 patients of the Institute diagnosed with coronary heart disease.

Around 15% of patients received a follow-up diagnosis of depression; far more than the 7.5-10% figure associated with the general population. Half of the patients with depression died during the 10-year study period compared to 38% who did not have depression. The research team admitted its surprise at just how big an impact depression had on the mortality rates of the patients.

Is Lack of Care the Problem?

It is common for depressed heart attack survivors to die because they lack the motivation required to maintain their health under difficult circumstances. They don’t follow doctor’s orders nor do they take their medication on time, every time. The AMA has directed cardiologists to use a short questionnaire to screen all heart attack patients for depression.

The AMA made the recommendation in 2008, but in the nine years since, studies show that relatively few patients receive the screening. Furthermore, only 42% of heart attack survivors with depression receive treatment. This figure is not far away from the troubling statistic offered by the National Institute for Mental Health, which says that only half of all Americans with depression receive treatment.

Cardiologists have fought back by saying they don’t have the time or expertise needed to handle the mental health requirements of patients. While this is true, it is troubling that doctors also fail to refer patients to cardiac rehabilitation programs.

These programs help reduce depression after heart attacks and reduce the risk of another adverse cardiac event. The AMA strongly recommends the rehab yet only two-thirds of patients receive a referral from their doctors. Even more concerning is the fact that only 23% of patients attended a single session and only 5% attended all 36 sessions. Rehab includes education, supervised exercise, stress management techniques, coping skills, and much more.


The link between depression and heart attacks is real. While it is easy to point the finger at patients who don’t follow the advice of their physician after discharge from the hospital, it is important to remember what depression can do to a person. Heart attack survivors with depression need support, and at present, the system is failing them badly.

In many cases, survivors only receive antidepressants after a suicide attempt. One wonders how many patients slipped through the net and succeeded in their attempt to end their life before any help was forthcoming.