Heart disease can also trigger depression, Genest points out. Cardiac rehab programs routinely test patients for signs of depression because the condition is so common after a heart attack or other heart disease event. Partly this is situational. Experiencing a life-altering illness can easily make someone depressed. But there can also be a biological component. Hardening and narrowing of arteries can decrease blood flow to the brain, which can lead to decreased brain activity which is linked to depression. And as Wulsin explains, the two conditions can occur in a vicious cycle that feeds on itself. What is crucial is that depression is treated, whether it precedes or follows heart disease.
Marie Plunkett can’t thank her caregivers at Ottawa Heart Institute enough for the support she’s had in managing her anxiety and underlying depression since her stent procedure last year. When she went in, she scored very high on the anxiety and depression scale. “And when I left I was probably the lowest,” she says. Along with the antidepressant prescribed by her doctor, “I took every course there I could,” says Plunkett. So much of the lifestyle advice for how to deal with heart disease is similar to advice for dealing with depression. Along with nutritional and exercise counselling, Marie took a stress management class run by social worker Bob Pelletier. “That’s what put me onto the road to recovery,” she says.
Pelletier tells his clients that “heart disease is a second-chance disease.” It gives people another opportunity to assess their lives and find ways to choose a more heart-healthy lifestyle. And that includes learning to manage their mental health. “We now see cardiac rehab in a much broader perspective,” he says.
What Pelletier’s class helped Marie do was to recognize her stress triggers and give her the confidence to make changes to reduce them. She made some major lifestyle changes, which included walking for 40 minutes every single day. “It’s like a fix, like a drug for me. Rain, snow – I’m out there,” she says. Usually, she walks along the Ottawa River near her home but, in the extreme cold, she heads to the local mall walking club. And every day, she retreats to her bedroom and plays her relaxation DVD for 20 minutes. “It’s just a lady talking. There’s music and [the sound of] water, but it calms you. Bob told us, ‘That’s your 20 minutes. Just relax.’”
Plunkett also changed how she related to some of the important people in her life. “I used to get so involved in my kids’ lives,” she says. She told her children that she didn’t have to know about every bad thing that they might be dealing with where she couldn’t help them. And she cut down on the amount of time she spent babysitting her grandkids in order to free up more time for herself.
The change has been remarkable. The walking has helped her drop almost 50 pounds, and the whole effort has reduced her chronic anxiety to the point where she wakes up every morning feeling excited to start her day. She’s taken up knitting; she enjoys reading, watching movies, doing crosswords – all things she couldn’t do before because her concentration was so poor. Now when she babysits her grandchildren, she can chase them around the park and have fun. “I’m a new person. I like myself. I have confidence I never had before. I can joke around. Before, I was always complaining,” she says.