The HeartBrothers' Patient Support Group recently heard from UMass Medical Center social worker Ellen Wells about how heart failure can impact patients’ mental health. Wells offered tips on identifying and managing depression, anxiety, and mood disorders.
Studies show heart failure patients are at risk for mental health issues, Wells said. In fact, 20-40% of heart failure patients experience depression and 50% of transplant patients report at least one significant episode of anxiety or depression within two years post-transplant.
“I struggle with a lot of anxiety,” said one woman who joined the PSG. “Anxiety symptoms can be the same as heart symptoms, so it’s a thing.”
Another woman cited PTSD, or Post-Traumatic Stress Disorder, as a big problem she continually faces.
Common Mental Health Diagnoses Among Heart Failure Patients
Wells described the mental health diagnoses that often afflict heart failure patients.
Anxiety is the body reacting to a perceived danger. “This can really wreak havoc on someone’s day-to-day functioning,” she explained. Symptoms include racing thoughts, restlessness, excessive worry, inability to sleep, muscle tension, and fatigue. Symptoms are often persistent and don’t go away. Too much anxiety can feel like a heart attack. Treatments can be extremely effective.
Sadness is a normal reaction to stress. Those grappling with sadness can still experience some hope and enjoyment. Sadness can improve with encouragement and engagement with others.
Depression symptoms can include a loss of interest in preferred activities, fatigue, low mood, loss of appetite, overeating, feeling worthless, and difficulty concentrating. Symptoms must be persistent for two weeks for a clinical depression diagnosis. “Depression is not sadness,” Wells said. It is an illness that must be treated.
PTSD symptoms include feelings of panic, low interest, withdrawal, persistent/exaggerated negative beliefs, and a persistent negative emotional state.
An Adjustment Disorder typically occurs when someone experiences a sudden change or stressor, and feelings of sadness and depression set in. Signs include maladaptive coping strategies, overreaction to the initial stressor, and impairment in social, occupational, and/or other areas of functioning.
Mood and anxiety disorders are the most common psychologial problems for both pre- and post-transplant patients, Wells explained. Adjustment disorder is very common for VAD (Ventricular Assist Device) patients.
Depression and Heart Failure: A Two-Way Street
Wells described a “two-way street” relationship between depression and heart failure.
“People with poor heart health are more likely to develop depression—twice as likely as the general population,” she said. People with depression are also more likely to develop heart problems because their higher levels of stress hormones can increase blood pressure, thereby negatively impacting the heart.
Wells emphasized the importance of not self-diagnosing, particularly because symptoms can overlap and often mimic each other. "It is important to get an evaluation from a professional,” she said, pointing out that ignoring mental health symptoms and not getting treatment can result in negative outcomes including higher hospital admission rates and higher mortality rates.
If mental stress is persistent, impacting day-to-day functioning, and you feel a low sense of purpose or quality of life, Wells strongly encourages being evaluated by a mental health professional.
For heart failure patients experiencing mental health challenges, Wells offered the following tips:
● Seek help. All diagnoses have evidence-based, effective treatments.
● Focus on what you can do, rather than what you can’t.
● Get active. Participate in groups like the HeartBrothers’ Patient Support Group, community events, etc.
● Social support is among the most established protective factors amid stressful life events and has been proven to improve coping skills.
● Reduce stress levels by eating healthy, exercising, meditating, and taking walks.
● There is always hope. Hope is the biggest predictor of survival.
Patient Support Group participants said connecting with other heart failure patients is hugely helpful.
“My husband was healthy," shared one woman. "He’d never been sick, and all of a sudden he was rushed to the hospital on Christmas Day and we were told that he needed a heart transplant,” said one woman. “I was trying to process everything at once, not even knowing what to do. You meet these people (other patients and families) for the first time, but you feel like you’ve known them your whole entire life. Unless you’re in that type of environment you don’t really know.”
The HeartBrothers Patient Support Group meets virtually the second Thursday of every month at 6:00 p.m. and is free and open to all. Learn more HERE.