Bill Golden, 67, initially went to the doctor because he had a metallic taste in his mouth, trouble eating and tense leg muscles that made it almost impossible to walk. His physician checked his arteries to observe blood flow and discovered two valves were 100% blocked and three were 70% blocked. Three days later, Golden had quintuple bypass surgery.
After three weeks in the hospital, Golden returned to his Bellingham, Massachusetts, home but still couldn’t walk. Cardiac rehab specialists visited Golden when he returned home, but he was unable to move his legs for the therapy. “I wanted to do it, but I couldn’t and was tired,” Golden says.
“It felt like the world was closing in on me. I just sat in a chair with a blanket on. The only time I left the chair was when the therapist would come or my wife would take me to the doctor. I knew I had to eat and exercise, but I didn’t have it in me. I started looking outside and seeing the work undone, and it got me down. I wanted an answer to the issue with my legs,” Golden says.
Golden is not alone in feeling depressed after a heart attack, diagnosis of heart disease or cardiac surgery or procedure. Studies show that up to 20% of patients who have undergone coronary artery bypass graft surgery and up to 15% of patients with cardiovascular disease experience major depression. Another study shows that up to 33% of heart attack patients experience depression. In reality, those numbers are likely higher, as approximately half of patients with depression are never diagnosed.
Golden recognized he needed to seek treatment when he saw his wife crying. “I realized not only was I hurting myself, I was hurting her. I knew I had to do something about it,” he says. It was then that he decided to seek physical and cardiac therapy at Brigham and Women’s rehabilitation center in Foxborough, Massachusetts. From his therapy, he began to see progress.
A Continuing Battle
For some, depression after a heart event is short-lived. For others, it’s longer lasting.
Alexandria Calhoun’s journey began when she was 19. When she went to the doctor for chest pain and shortness of breath, her physician thought she had severe heartburn. After her condition worsened, she was referred to a cardiologist. An angiogram reveled Calhoun had six major blockages requiring a quintuple bypass. “I was told I should be good at least 10 or 15 years. I thought I was cured because when you’re 19, that seems like a long time,” Calhoun says.
Unfortunately, Calhoun’s heart problems have persisted. Now 37, the Stockton, California, resident has had four heart attacks, 10 balloon angioplasties, eight stints, and two ablations.
“It started as frustration and then sadness. It was very gloomy,” Calhoun says. “I was having so many procedures back to back – in my mind that didn’t look good. It felt like my future was getting shorter.” To treat her depression, Calhoun saw a therapist and a psychiatrist, and she took an antidepressant. After a couple of years of treatment, she felt more positive.
But in May of 2016 after Calhoun’s second ablation, the depression returned. “A few weeks later, I was crying all the time; I was really sad. I told my fiancé I didn’t think it was fair to him, but he stuck with me. I have so much anxiety over my next procedure,” Calhoun says. Although it’s unknown what that next procedure will need to be, Calhoun’s doctor is encouraging her to get on the non-priority heart transplant list at Stanford University.
“I get in that dark, sad world, and I think, ‘I’m on 12 medications. I have appointments every week. I have to get my blood drawn all the time,’” Calhoun says. “I want an end, and it doesn’t seem like it’s ever going to. I may never have peace until I’m dead, and that scares me.”
Calhoun started taking an antidepressant again, but she still struggles with depression. “It’s so hard for me to be hopeful because I get sad thinking, ‘Is all I have to hope for my next procedure?’ That’s not the quality of life I ever imagined for myself,” she says. “I try to remind myself I’m still here and still have a purpose. My four heart attacks haven’t taken me out. I still have a lot to be thankful for.”
‘A Fear of Dying’
Ruth Lynne Hunnings, 66, also has battled depression. “It felt like a ton of bricks on my shoulders, like a cloud over my head all the time. It was very difficult to see the sun. Once in a while you’d see the light, and you’d have hope,” says Hunnings, an Eaton, North Carolina, resident.
When she was experiencing sluggishness and difficulties getting out of bed each day of the year leading up to her heart attack, she thought it was a cycle of depression, something she’s fought periodically since the ’80s. Hunnings didn’t realize it was her heart. In 2003, she had bypass surgery. Then in December of 2015, she had congestive heart failure. After stent and balloon procedures and cardiac rehab, Hunnings had to have her aortic valve replaced and mitral valve repaired due to severe leakage.
“Going through open heart surgery the second time was much more difficult than the first time. I was 12 years older. I was on the operating table much longer. I felt the effects of the heart-lung machine stronger this time,” Hunnings says. “The experience scared me to death. It caused me to examine many things about myself, about God, about my family. Your life is never the same again. The physical damage is hard to overcome.”
For Hunnings, this latest battle with depression was different than before her heart event. “It was over the loss of who I was and had been activity-wise. I couldn’t do the things I used to. People used to pick on me that I was the fastest-walking person they’d ever seen. When I wanted to get something done, I got it done. I can’t anymore,” she says.
“You do go through a fear of dying — not so much fear of the beyond, but fear of letting go and of not finishing what you want to do here,” Hunnings says.
Depression after a heart event can stem from a number of circumstances surrounding the situation, including not knowing what to expect moving forward or not being able to complete even simple tasks without becoming tired, as Golden experienced.
Three months after his bypass surgery, Golden started walking again. His doctor now thinks Golden had atypical polymyalgia rheumatica (PMR) caused by heart attacks he didn’t realize he’d had.
A diagnosis and progress help with the despair, but not every patient is fortunate enough to see the progress they crave. “For the past 17 years, I haven’t been Alexandria. I’ve been a case. I’ve been an unusual case, an exciting case. I just feel like a freak of nature sometimes. Everyone wants to meet me and see what I look like because this is something unseen. And then I look normal, and they’re disappointed,” Calhoun says.
Screening for All Heart Patients
Although it’s expected that one would feel sadness temporarily after a heart event, those feelings should subside after a few weeks. If the sadness is severe and accompanies other symptoms that occur every day for two or more weeks (see sidebar, “Signs of Depression”), it’s important to seek treatment — not only for emotional health, but for physical health as well.
Ongoing depression can lead to a weakened immune system, high blood pressure, arterial damage and irregular heart rhythms. Essentially, it perpetuates the cardiac issues that caused the depression.
For someone without existing heart disease, depression can increase the risk of a heart attack and the development of coronary artery disease. For those with existing heart disease, it can increase the risk of an adverse cardiac event, such as blood clots or a heart attack.
In fact, according to a study published in the Journal of the American Medical Association, ongoing depression after a heart event increased the risk of death to 17% within six months after a heart attack, compared to a mere three percent in heart attack patients without depression. It can also amplify fatigue and pain during recovery.
Because of the risk factors depression poses, the American Heart Association recommends all cardiac patients be screened for the condition.
If you think you might be depressed, it’s important to see your primary care physician. He or she can prescribe treatment that often includes medication and counseling.
“One of the biggest things that helps is finding a counselor who will talk to you not only about coping mechanisms, but is not afraid to preach and talk about spiritual matters too because they’re very important,” says Hunnings, who also cites her faith as a source of comfort.
Calhoun also understands the importance of finding someone to talk to. “I feel like I can’t express myself to my family,” she says. “They get very emotional, and they say I’m giving up. I’m like, ‘I never said I’m suicidal. I’m just sad and frustrated.’ Then I hold the feelings in, and that’s not good. Or I eat a cheeseburger, and that’s not good. So I’m trying to find other coping mechanisms.”
In speaking with other heart patients, Calhoun has realized they, like her, are hesitant to talk to their families about depression. Part of this stems from a fear of seeming ungrateful after surviving.
Golden notes the value of joining a support group like Mended Hearts. Volunteering with Mended Hearts has provided some relief for Calhoun as well. “Sometimes there’s that loneliness, and you wonder if you’re the only one who feels sad after a procedure,” she says. Spending time with people in similar situations can help. And all three are enthusiastic about volunteering to visit other patients in the hospital.
“Find what’s happy inside of yourself. And bring that out for other people to see, and that will enrich your happiness that much more,” Calhoun adds.
Cardiac therapy and the camaraderie that can develop there also are helpful. Hunnings found comfort and encouragement when a cardiac therapist told her about an older patient who made impressive progress. “It’s given me a new determination. With hard work and diligence, I can get there,” Hunnings says. “Talk to other patients who have had similar experiences. See the progress people have made. You’ll feel so discouraged at first. You’ll think, ‘Why bother?’ But actually see the progress others are making so you can picture that in yourself.”
For Golden, physical activity was the key. “Once I started exercising, going to rehab, that got me out of the depression,” Golden says. “I’d pick one thing I couldn’t do, and I’d challenge it. Once I got up and started moving, once I saw I could do that, I felt so much better. My depression started leaving me.”
He adds: “Don’t skip rehab. Don’t just sit there on the machine and pedal and ignore the people around you. It helped me so much to have the people around me cheering me on.”
In addition to exercising, eat healthfully and get adequate amounts of sleep.
It’s also important to give yourself time and grace. “A friend told me it’d take me one year to really come back after this operation. It’s nearly been a year, and it seems like it’s coming back,” Golden says. “It’s going to pass. It’s not going to pass fast, but you’ve got to understand the damage you’re doing to yourself by sitting around and the damage you’re doing to your family.”
Hunnings seconds his encouragement: “Press forward. Look forward to each coming day. Find at least one happy thing each day. I read that back when I was depressed, and I thought that was crazy. But if you work hard enough, you can see it.”
Calhoun also notes the importance of seeking positivity. “I hope when someone reads this, they get hope, that they don’t think like I did before that this is never going to go away or that they’ll never have a life again. That’s not true,” Calhoun says. “There’s still a lot to live for, still a lot to be hopeful for. You just have to find it. Not everyone is fortunate enough to find it right after they wake up from surgery, but that doesn’t mean it’s not there.”