Coping with anxiety and depression

Margaret Brain

Many people with heart conditions face mental health issues as a result. Sarah Brealey hears how Margaret Brain beat hers and shows where you can find help.

“I didn’t want to go out; I didn’t want to meet anyone. If people asked me how I was, I would dissolve in floods of tears. I felt like I couldn’t cope.” That’s how Margaret Brain, 65, from Worcester felt two years ago, after she had a cardiac arrest.

As our survey shows, she’s not alone. Existing studies suggest people with cardiac conditions are three times more likely to suffer from depression and/or anxiety than the general population.

There are many reasons for this, says André Tylee, Professor in Primary Care Mental Health at King’s College London. “Heart disease is a serious, potentially life-threatening condition,” he says. “A heart attack, for example, is a traumatic event that can leave people wondering if they’re having another one every time they get chest pain. That’s very stressful.” A heart condition can also bring a wider sense of loss, he says, whether it’s an awareness of ageing, the fact you’ve had to stop working or socialising, or its effect on relationships.

At times of extreme stress, trauma often gets pushed down and may not emerge till months later

Margaret, a retired primary school teacher, was 58 when she suffered a cardiac arrest. Her daughter, Helen, helped save her life by giving her CPR until the paramedics arrived. She was subsequently fitted with an implantable cardioverter defibrillator (ICD) to shock her heart if it had another life-threatening rhythm.

Although Margaret says she coped well at the time of the cardiac arrest, she noticed signs of depression two years ago, after her ICD delivered a shock. She says: “I remember waking up and feeling strange, like I’d just come round from a faint. But I didn’t realise what had happened until my hospital appointment a month later, when they took a reading and they said, ‘Yes, you have had an event on your ICD.’

I said to the cardiologist, ‘I could have died.’ I think that’s what triggered everything. Maybe it brought back all the pent-up emotions from the initial cardiac arrest. I’d never felt that way before,” she says. “I didn’t know what to do to cope. I was really annoyed with myself for getting into such a state, especially as nothing really bad had happened.”

Symptoms of anxiety and depression

A patient listening to her GP doctor Depression and anxiety are two of the most common mental health diagnoses in the UK. The two conditions often go hand in hand. Anxiety is a feeling of unease, such as worry or fear, and can be mild or severe. If the feelings are frequent or constant, hard to control and affect your daily life, you may need help to break the cycle.

Depression can mean feeling sad, hopeless or tearful, or losing interest in things you used to enjoy. Most of us have these feelings at times, but seek help if it lasts for weeks or months, rather than days.

If you answer yes to any of the following questions, it may be worth contacting your GP for assessment and possible treatment. You can use a more detailed tool on the NHS website.

During the past month:

  • Have you often been bothered by feeling down, depressed or hopeless?
  • Have you often been bothered by having little interest or pleasure in doing things?
  • Have you often felt unable to stop worrying or that you were worrying too much?
  • Have you often felt nervous, anxious or unable to relax?

Support is out there

It’s not unusual to have a delayed emotional reaction to a heart event, says Professor Tylee: “At times of extreme stress, the trauma often gets pushed down and may not emerge till months or even years later.”

Margaret thinks her depression was caused by feeling isolated and out of control – common factors for people with long-term health conditions. In Margaret’s case, she didn’t know anyone else who’d had a cardiac arrest or ICD. “I felt out on a limb,” she says.

She wasn’t allowed to drive for six months after receiving the shock, making her feel helpless and preventing her from socialising.

Just being with other people helps enormously. Being together, supporting each other, is crucial

As Margaret’s experience shows, depression can have a huge impact on your quality of life. It can even affect your heart health. People with coronary heart disease (CHD) and depression are twice as likely to have future heart events or die than people who have CHD but aren’t depressed. And if you don’t have heart disease, suffering from depression increases your risk of developing it by 60 per cent, even after taking into account other risk factors.

You don’t have to suffer in silence; effective treatments are available. You can learn more about antidepressants, but these aren’t the only option. Professor Tylee says: “We now have vastly improved access to psychological treatment. Although more access is needed nationally, we now have the Improving Access to Psychological Therapies [IAPT] programme in every area of England.

There is a whole range, not just cognitive behavioural therapy – which is extremely well backed by evidence for treating depression, anxiety and trauma – but also counselling, interpersonal therapy and relationship therapy. You don’t even have to see your GP in England, you can go directly to the IAPT service.” However, there are slightly different systems in Scotland, Wales and Northern Ireland, so in those areas it may be best to contact your GP first, or see ‘Where to find help’, below.

Margaret did go to see her GP, who offered her medication and talking therapy. She decided to wait for a few weeks and found she was feeling better. Many people find their emotional reaction to a heart event or diagnosis diminishes gradually over time, but if not, don’t be afraid to ask for help.

Margaret Brain with her husband, BertFamily members, especially her husband, Bert, and daughter, Helen, have been a huge source of support for Margaret. But she says her condition has affected them, too – in particular, Bert and Helen were traumatised by witnessing her cardiac arrest. She says: “The effect of a heart condition isn’t just on the patient.”

Family members are eligible for NHS psychological help, too. If a loved one has health problems, it can affect your mental health. Being an unpaid carer is closely linked with higher rates of depression. Unfortunately, having a heart condition or fulfilling a caring role can make you more isolated, and social isolation increases the risk of depression.

It’s important to connect with others. Heart Support Groups, an exercise class or a bit of volunteering can help you feel more in touch. Whether you’re a patient or a carer, support from others can be a good way to deal with depression or anxiety, particularly if your symptoms aren’t severe enough to need medical treatment.

Margaret attends her local Heart Support Group. These are run by and for patients and carers, supported by the BHF, and are a great way to meet people with similar experiences. Professor Tylee says: “Just being with other people helps enormously. Being together, supporting each other, is crucial for all of us.”

Where to find help

10-minute TIME OUT

A man sitting in a relaxed positionLearning how to relax can be a big help if you’re trying to deal with stress. For a quick and easy relaxation technique, simply tune in to your breathing. Take one deep breath in, hold it, then tell yourself to ‘let go’ as you breathe out through your mouth. Breathe naturally for a while, then repeat the deep breath in and let go with your outward breath.

Next, tense and then relax the muscles in one part of your body, such as your hand, foot or stomach. When you let go, try to let the tension slip away. Repeat with other parts of your body. Remember these relaxation skills. You can apply them to cope with any situation when you start to feel stressed.

Our 10-minute guide "Take time out" has more stress-busting tips. Download the guide.

More useful information