Overview, Causes, & Risk Factors

Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own.

What is going on in the body?

Several factors can make a person feel depressed after a heart attack. The stress of being in the hospital, the fear of another heart attack, and the reality of having to make lifestyle changes can all contribute. If the person had to have bypass surgery, he or she will have to endure a long recovery period. This could include being out of work for up to six weeks.

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of the following:

certain illnesses

certain medications, including antibiotics and medicines used to treat acne

changes in brain chemicals

heredity

hormonal changes

lack of sunlight

major stresses

negative thinking patterns

Risk factors for depression include the following:

alcohol abuse

drug abuse and addiction

hormonal changes

job strain

personal or family history of depression

personal history of a suicide attempt

stress

Depression and heart attack have a complex relationship. People with a history of depression have a much higher incidence of heart attacks than people without depression. A person is more at risk for depression after a heart attack if he or she has suffered from depression in the past.

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Symptoms & Signs

What are the signs and symptoms of the condition?

Some symptoms are common in people of all ages with depression. These symptoms include the following:

appetite problems

decreased energy

difficulty paying attention or making decisions

feeling very sensitive emotionally

feelings of irritability

feelings of sadness, despair, and emptiness

inability to feel pleasure

loss of motivation and withdrawal from others

low self-esteem

pessimism, negativity

sleeping problems

thoughts about suicide and death

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Diagnosis & Tests

How is the condition diagnosed?

A person who shows signs of depression after a heart attack should have a comprehensive evaluation. The evaluation may include a medical history, physical examination, and laboratory tests.

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Prevention & Expectations

What can be done to prevent the condition?

Depression may not be preventable. Following are some steps that may be helpful in preventing depression.

Avoid alcohol and illegal drugs.

Avoid cigarette smoking.

Get prompt treatment for other psychiatric disorders.

Seek effective treatment for chronic diseases.

Talk with a counselor if major trauma has been experienced.

Depression can lead to suicide. It is important to recognize and treat the condition early. Individuals should be encouraged to talk to someone if they are concerned about depression. There are many people they can talk to, including the following:

a clergy member

a counselor

a family doctor

a professional at a mental health center

a psychologist

a trusted family member

What are the long-term effects of the condition?

Following a heart attack, people with depression are less healthy and functional than those without depression. Recent research findings include the following:

People who are depressed after a heart attack rate their physical health lower than those who are not depressed.

People with depression after a heart attack report a significantly lower quality of life than nondepressed individuals.

Depression significantly increases a person's risk of dying from heart disease.

Depressed women with chest pain were three times more likely to smoke than other women with chest pain.

Depressed women with chest pain were four times more likely to be impaired in their daily activities than women without depression.

People who have depression are at much higher risk for stroke, further heart attacks, and heart disease than people who don't have depression.

People who suffer from depression after a heart attack are less likely to make the lifestyle changes necessary to decrease the risk of another heart attack. These changes include the following:

getting regular exercise

lowering intake of dietary fat and cholesterol

reducing stress

quitting smoking

What are the risks to others?

Depression is not contagious and poses no risk to others.

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Treatment & Monitoring

What are the treatments for the condition?

The two most common ways of treating depression are with antidepressant medications and psychotherapy. Often a combination is used. Occasionally a person must be hospitalized for intense treatment or for his or her own safety.

Antidepressant medications are effective in the following ways.

They increase the person's ability to function in daily life.

They lower the risk of suicide.

They make the person feel better.

The following types of medications are used to treat depression:

tricyclic antidepressants, or TCAs, including amitriptyline HCl and desipramine HCl

tetracyclic antidepressants, such as maprotiline HCl and mirtazapine

monoamine oxidase inhibitors, which are also called MAOIs, such as phenelzine sulfate and tranylcypromine sulfate

selective serotonin reuptake inhibitors, or SSRIs, including paroxetine HCl and fluoxetine HCl

other antidepressants, such as nefazodone and venlafaxine

Psychotherapy can help people do the following:

cope better with having depression

feel less alone

improve relations with family, friends, and coworkers

learn about depression and how it affects them

learn to recognize and avoid situations that can bring on a depressive episode

learn to view the world and others more positively and more realistically

positively address problems that they may be facing

stop episodes of depression early by recognizing warning signs and symptoms

What are the side effects of the treatments?

Antidepressants may cause mild and usually temporary side effects in some people. Following are the most common side effects:

agitation

constipation

dizziness

drowsiness

dry mouth

nausea

What happens after treatment for the condition?

An individual can help prevent relapses by living a healthy lifestyle. Following are some important parts of a healthy lifestyle:

avoiding alcohol, illegal drugs, and smoking

doing regular exercise

eating a balanced diet, following the food guide pyramid

finding ways to manage stress

finding a support system for dealing with depression

getting enough rest

How is the condition monitored?

Once a person has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medications.

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