Ask the Doctors

Dear Doctor: It has been six weeks since my husband, who is 57, had a heart attack, and I'm afraid he's depressed. His doctors say he's doing really well, but he's getting more quiet and withdrawn. How can we help him?

Dear Reader: Depression following a heart attack is not uncommon. Up to one-third of people who have had a heart attack report symptoms of depression. It's not just the body that suffers the effects of a heart attack -- there can be a mental and emotional toll as well.

A person who goes through a life-changing medical event -- and a heart attack certainly qualifies -- often faces an emotional struggle once the initial danger is past. He or she can wind up feeling alone, frightened and fundamentally different from everyone around them. Even when surrounded by a loving family and caring friends, these feelings of isolation can be profound.

The first challenge is to recognize that something is wrong.

In addition to becoming quiet and withdrawn, symptoms of depression include anxiety, persistent feelings of sadness, problems with concentration, and a lack of interest in the people and activities that were once important. There may be changes in appetite or in eating habits, as well as changes in sleep patterns, whether insomnia or sleeping too much.

One danger posed by depression is that heart patients may not fully engage in their recovery. They may not be careful to always take their medications, and may either put off or refuse to make the lifestyle changes recommended by their doctors. Studies have shown that individuals who are depressed may be twice as likely to have another heart attack.

The most effective treatments for post-heart attack depression are anti-depressants and seeing a therapist, such as a psychologist or psychiatrist. Anti-depressants can ease the burden of the difficult feelings that have derailed the patient's journey back to normal daily life. And in talk therapy, patients can safely explore their fears, pinpoint their anxieties, and gain an understanding of the many ways that surviving a heart attack has reshaped their lives.

If your husband isn't interested in the one-on-one environment of a therapist's office, then a support group is a good alternative. The chance to meet other heart patients and to hear their stories and to share his own can go a long way toward piercing the wall of isolation.

Another excellent avenue of support is something called cardiac rehabilitation. It's a highly structured program, usually 36 weeks long, that includes exercise, education and counseling, all done under careful medical supervision.

The cardiac rehab team typically consists not only of doctors and nurses, but also dietitians, exercise physiologists and other professionals. Participants attend classes and lectures, get important information about the medications they are taking and learn how to return to their daily lives.

Most of all, I suggest talking to your family doctor, who can help you with whichever path your husband is willing to pursue.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

More like Ask the Doctors