Living with cardiovascular disease can affect your mental health. For some, antidepressants can help. Chris Dickens, Professor of Psychological Medicine at the University of Exeter, answers questions from Senior Cardiac Nurse Amy Thompson.
Being diagnosed with cardiovascular disease (CVD) or having a heart event can make you prone to depression as our exclusive survey shows. Heart disease can effect emotional wellbeing, your relationships, and how you see yourself. However, it isn’t always recognised. So what are the signs, and can medication help you?
How do you recognise the signs of depression?
Depression is often undetected in people with CVD. Doctors, nurses and those diagnosed with CVD are understandably preoccupied with sorting out the heart problems first, and depression can be overlooked. There’s some overlap between the symptoms of depression and CVD. So, when people feel they lack energy and can’t do the things they used to, it can be attributed to the CVD and the early signs of depression may not be noticed.
Depression is often undetected in people with cardiovascular disease
People can also be reluctant to admit they feel depressed, and professionals may not want to suggest that depression might be contributing to their problems. As a result, many go without the treatments that could make them feel better. If you think you may be depressed, speak to your GP.
How do you treat depression?
The choice of treatment will depend on the severity of the depression, what your doctor or nurse thinks is most likely to help and, very importantly, what you would prefer. Most people opt for talking therapies first, but may go on to be prescribed an antidepressant, particularly if they do not respond to talking therapies.
What are antidepressants?
They are a group of medicines that can help relieve the symptoms of depression, shorten the awful experience and even prevent it from coming back. They can also treat some other conditions, such as anxiety or chronic pain.
There are several types of antidepressants. Each has a different chemical structure and way of working, so side effects vary. Selective serotonin reuptake inhibitors, or SSRIs (including citalopram and fluoxetine), are the newest and are widely used because they work well and have fewer side effects. Less commonly used antidepressants include monoamine oxidase inhibitors (such as phenelzine) and tricyclic antidepressants (which include amitriptyline and dosulepin). There are also types that don’t fit neatly into these groups.
How do they work?
They alter the amounts of the chemical messengers in the brain that we believe are associated with depression. These are called neurotransmitters and affect your mood and emotions. Each type of antidepressant works on different neurotransmitters to different degrees, which explains the variations in their effects and side effects.
What are the side effects?
Antidepressants can take up to a couple of weeks to start working and can continue to increase in benefit for weeks and months after
They vary with the type of antidepressant, but most are fairly mild, come on quickly (sometimes after a single dose) and ease off within a few days. For example, SSRIs may cause an upset stomach, while tricyclics are known for causing a dry mouth and blurred vision.
As with any medicine, the list of all possible side effects is long, but the majority of these will not be a problem for most people. Speak to your GP if you have any concerns.
Do you take them for life?
Once the signs of depression have disappeared, people will usually keep taking their prescribed antidepressant for six months or longer. This may seem strange, but we know that this significantly reduces the chances of the depression returning once you stop taking the medication.
Are they addictive?
No, because they do not cause ‘tolerance’, meaning you do not have to keep increasing your dose for them to continue working. Some people do experience withdrawal effects once they stop taking antidepressants, particularly if they come off them suddenly. Withdrawal effects, including very light flu-like symptoms, are usually mild and settle quickly.
Can I take antidepressants if I have a heart condition?
Yes, but you will have to take the right one, depending on the nature of your heart condition. For example, tricyclics are contraindicated (can not be prescribed by your doctor) during the recovery period following a heart attack.
How will I know they are working?
It’s not like paracetamol, where you take it for a headache and an hour later your symptoms have disappeared. Antidepressants can take up to a couple of weeks to start working and can continue to increase in benefit for weeks and months after.
Where to find help