It was only after I survived a heart attack that I first got an insider’s perspective on how it actually feels to be depressed. Really depressed. Really, seriously depressed. Up until then, like many of you reading this, I was disdainful of this particular mental health diagnosis, often silently smirking things like: “Oh, for Pete’s sake, why can’t they just pull up their socks, quit whining, and get on with it?”
But after my heart attack, absolutely convinced by every twinge that yet another horrific cardiac event was imminent, I somehow fell into the grip of an icy, low-grade terror, what Frances Perkins has described as “the slow menace of a glacier”. I knew something was terribly wrong with me, but could not seem to pull myself out of this dark hole that was my new life.
Later, while at Mayo Clinic, I was actually relieved to learn that these ongoing feelings of profound despair were common among heart patients. In fact, I learned from cardiologists there that up to 65% of heart attack survivors experience significant depression, yet fewer than 10% are appropriately identified.
Cardiac psychologist Dr. Stephen Parker (and a fellow heart attack survivor who also experienced severe depression himself) writes:
“I think the depression and anxiety following a heart attack are different than the depression and anxiety that most therapists encounter, and both are going to be more resistant to treat because there are damned good reasons to feel anxious and depressed.
“A heart attack is a deeply wounding event, and it is a wound that takes a long time to recover from, whatever the treatment.”
And as British writer Polly Toynbee described us:
“These are not the ‘worried well’, but those in severe mental pain with conditions crippling enough to prevent them living normal lives.“
I wrote about my long journey through depression and back in an essay called The New Country Called Heart Disease. As you might imagine, I’ve also given considerable thought to the best ways to live through depression when it hits.
A 10-year Dutch study found that 76% of depressed patients who did not take any antidepressant drugs recovered and never relapsed. Another five-year study of 9,500 Canadian patients in Alberta concluded that the drug-taking group were depressed on average for 19 weeks, but those who did not take antidepressants were depressed for only 11 weeks. And the World Health Organization has found that non-medicated patients with depression enjoyed better health than those who took antidepressants.
It’s important to keep in mind that most published research favouring the use of antidepressant drugs has been funded by the drug companies that manufacture those antidepressant drugs.
A depression diagnosis has gone from being what was described in the 1960s by leading medical experts as a self-limiting, episodic disorder showing spontaneous recovery without treatment after a few months to now being considered a more chronic, drug-managed illness.
It’s also important to acknowledge that, for some patients experiencing debilitating and severely life-limiting symptoms of depression, meds may indeed be the best treatment option.
There are, however, a number of effective non-drug options to manage lesser depression symptoms. For example, talk therapy is often recommended, and daily exercise is now viewed as one of the most successful therapies available.
When former Globe and Mail reporter Jan Wong wrote about her own journey with severe depression in her memoir Out of the Blue, she described the ultimate life lessons that depression had taught her:
“The big life lessons are that you can have clinical depression and you can get over it. It’s completely treatable. It has an end.
“Second life lesson: you’ll probably be stronger when you come out of it than you were before.
“The third life lesson is you’ll probably be happier because you leave it behind and you will find a new life.
“The fourth lesson: that family matters. Everything else is extra.”
And here’s a thumbnail guide from the independent experts at Consumer Reports Health to help you decide if you should consider taking antidepressant medications:
“If you are feeling “down” or “blue” – for example, in the wake of a stressful life event, such as the death of someone close, a divorce, or a job loss – you may have mild depression. That’s especially likely if you are still able to function and have no history of depression. Your symptoms will usually ease on their own within a few months, aided, if necessary, by family support and professional counselling, without the use of any antidepressant drugs.
“But if you are not functioning well and your symptoms have lasted for several weeks, you may be a candidate for an antidepressant drug. That is especially true if there is no apparent reason for you to be depressed, or if you have had repeated episodes of depression.
“Your doctor may not be aware of price differences between medicines, so be cautious if he or she offers you a free sample of expensive, brand-name drugs that they happen to have in their office. While the free price may be tempting, the drug may not be the right one for you. Individual needs vary and people respond to antidepressants quite differently. Some have to try two or three antidepressants before finding one that works.
“Taking effectiveness, safety, side effects and cost into account, Consumer Reports Best Buy Drugs has identified five medication options to consider for depression:
- Generic bupropion (brand name: Wellbutrin)
- Generic citalopram (brand name: Celexa)
- Generic fluoxetine (brand name Prozac)
- Generic paroxetine (brand name: Paxil or Pexeva)
- Generic sertraline (brand name: Zoloft)
“According to independent research by Consumer Reports Health, these medicines are substantially less expensive than brand-name antidepressants and are equally effective.”
See more about depression from my other site, Heart Sisters.
- The New Country Called Heart Disease
- 10 Non-Drug Ways to Treat Depression
- Depressed? Who, Me? Myths and Facts about Depression Following a Heart Attack
- “I’m Not Depressed!” – and Other Ways We Deny the Stigma of Mental Illness After a Heart Attack
- Is it Post-Heart Attack Depression – or Just Feeling Sad?
- Handling the Homecoming Blues
- Depressing News about Women’s Heart Disease and Depression
There is a real problem with antidepressants- they do little more than placebo in mild to moderate depression. Whilst 97% of company funded trials show a benefit, when all trials (including unpublished) are included, this drops to 50%.
Irving Kirsch (author of the Emperors New Drugs) takes this even further and contends that the ONLY effect of antidepressants is a placebo one, ie you feel better because you take a pill not because of the action of the pill.
Hi Dr. Joe – I saw the Kirsch interview on 60 Minutes. Pretty compelling material. He does contend that antidepressants MAY be useful for those experiencing “extreme levels of depression”. Trouble is, when patients are desperate enough, they’ll grab at anything that might make them feel better. And the DSM-5 will make it even easier for docs to prescribe these drugs (e.g. new guidelines that will now categorize normal bereavement grief as clinical depression).
Whether or not to take anti-depressants is a complicated issue; they are not as effective as Big Pharma would have us believe (although believing would be helpful.)
Each person reacts differently to anti-depressants, and what may seem effective for one person does not work for another. Some people, for instance, cannot metabolize Prozac.
After being prescribed Zoloft, I dreamt my garage was covered in this thick green radioactive goo, the exact color of Zoloft. This was not a good prognostic sign, to say the least.
The research also overwhelmingly shows that anti-depressants are much more effective when combined with talk therapy, yet most physicians fail to recommend and ensure that their patients are in counseling if they are prescribed anti-depressants.
Also, I would note that most studies of depression after heart attacks fail to take into account the severity of the heart attack — how much heart function one has lost and how much pain one is in contributes greatly to the psychological territory one inhabits.
Thanks for your perspective as a heart attack survivor, Dr. Steve. I suspect that the failure of physicians to recommend talk therapy has more to do with insurance coverage than with good doctoring. Your points on heart attack damage are excellent and utterly under-appreciated by the medical profession.