Depression and Heart Disease 
Genesis Works to Identify Symptoms in Cardiac Patients 
(Posted 12/11/06)

Joe Harper lost control of his orderly life the day he experienced life-threatening chest pain and was admitted to Genesis Medical Center, Davenport, to await quintuple bypass surgery.  

The ex-Marine and driven businessman who prided himself on his ability to lead and take control faced sudden vulnerability.  For five days before surgery, he laid in a hospital bed with too much time to think about his own mortality and the five clogged vessels choking his heart. 

He couldn't get his fingers around the helplessness: Surgeons would open up his chest; crack open his rib cage; and literally hold his heart in their hands while a machine kept his body functioning.  They, no him, would determine his destiny.  Meanwhile, he discovered that hospital life did not - and would not despite his insistence - revolve entirely around Joe Harper's schedule.  

For him, it was the ultimate loss of control.  "It was a terrible time," Harper of Davenport said.  "I was very mad at the world.  I didn't have control, and that was such a hard adjustment." 

The 49-year-old body that had led him through the rigors of Marines training and an active lifestyle had betrayed him.  Dark thoughts weighed in.  He updated his will.  He pondered death.  He pondered living life with heart disease as "the boss." 

Today, 16 years later, Joe and his wife, Sally, still shed tears when they remember those 10 days in the hospital and the ensuing six months of depression that followed his five-vessel bypass surgery.  On this day of their 42nd anniversary, the couple remembers a time when Joe's depression nearly broke their hearts. 

"Joe is a Type A personality who was accustomed to working a lot of hours and needed to have control," Sally recalled.  "When he got home from the hospital, he couldn't drive; he wasn't allowed to work for several weeks; he had to take it easy.  So he paced and he paced and he paced.  It was a very hard time."  

She remembers being warned that her husband could experience depression in the weeks following bypass surgery.  "It still was hard to understand," she said.  "He was just so angry.  I kept thinking: 'What are you mad about? You've lived through surgery. Why aren't you happy.' " 

"I was just in the tank," Joe said.  "I couldn't get myself going." 

Depression and heart disease
The Harpers later learned what research has demonstrated:  Depression and heart disease have a strong and sinister link.  Each can lead to the other. 

People with heart disease are more likely to suffer from depression than healthy people.  Those with depression are at greater risk for developing heart disease.  

In response to this growing awareness, Genesis Medical Center, Davenport - home to the region's largest heart program and the only hospital in the region to have four phases of cardiac rehabilitation - is developing a program to more systematically screen and identify heart patients with depression.   Once identified, the goal is to link them to treatment. 

"Inpatients who have had a heart attack or open-heart surgery are screened with two questions:  'During the last month, have you often been bothered by feeling down, depressed or hopeless?' and 'During the past month, have you often been bothered by little interest or pleasure in doing things?' said clinical psychologist Janis Smith, Ph.D., who is on the Genesis Medical Center staff. 

"What we're finding, just as we would expect, is that about 20 percent of patients will screen positive for depression.  if you read the research in this area, about 15-20 percent of people will be clinically depressed after having a heart attack.  About 20 percent of patients are depressed after bypass surgery." 

The effort at Genesis launched last summer.  Francy Ricketts, Ph.D., a local psychologist and member of Riverbend Psychological Association, collaborated with Dr. Smith and the Genesis Cardiac Rehab program to conduct depression screenings and education for cardiac patients.  Any Furgason, LCPC, of Southpark Psychology, Moline, gave cardiac rehab staff a presentation on depression in heart patients. 

The hope is that increasing patient awareness will increase their likelihood of seeking treatment.  Patients receive information about depression and are encouraged to talk to their family physician, cardiologist, or a mental health professional.  Treatment for depression can include cognitive behavioral therapy or medication. 

"We want them to realize there's a big difference between feeling a little down and having clinical depression that can worsen their cardiac outcome," Dr. Smith said.  "Many people are not aware that depression is an independent risk factor for heart disease.  This has been found in numerous and large longitudinal studies. 

"It's possible that patients are depressed before they ever have the heart attack.  After the heart attack, there's also vulnerability in knowing that their heart is not working like it should.  Once diagnosed, patients must cope with significant lifestyle changes.  They might have to take more medication; quit smoking; change their eating habits or become more physically active." 

Karen Doy, supervisor of cardiac rehab at Genesis, Davenport, has worked with heart patients for 20 years and dealt with all kinds, including those who are depressed.  Since 2000, Phase II cardiac rehab patients fill out a health assessment that includes a question about their mental health.  If they score low, they take a more in-depth assessment to help pinpoint depression.  Screening patients will help reach a much broader segment of people, she said. 

"A depressed person is more apt to smoke, not take their medication or to follow-up on their care," Doy said.  "Often you can see the signals when you talk to them.  They have excuses for not seeing their doctor or taking their medication.  They send out clues by saying, 'My spouse doesn't understand why I feel this way' or 'I don't even know why I'm here' or 'Yeah, I know I should exercise.'  Some need help moving forward." 

A New Life
Doy still remembers the day that Joe Harper, always fighting for control, exercised on the treadmill backwards in cardiac rehab.  The two laugh now about the incident.  Joe says he was just trying to make light of a challenging situation in life. 

"I was very upset the first day I checked into rehab," Joe recalled.  "I didn't think I needed to go through with it, and I was probably the youngest patient there.  Karen told me I had to fill out some paperwork, and I took exception with that and told her 'You guys should have done that for me.'  Karen set me straight."

"She and the cardiac rehab staff were wonderful and helped me get it back together.  You just can't place a value on what they do at Genesis.  Cardiac rehab is so much more than exercising.  It's a lot of mental work, too." 

Joe, no 66, didn't seek treatment for his depression:  "Had I told my doctor, he would have been able to help me.  But I was far too proud to do that."

Sally added, "His Type A personality was telling him 'I can get better on my own.  I don't need help.  I'm not going to lay my life out on the table and let people see my inner side.' " 

Today, Joe leads a very different life.  He has learned to slow down.  He exercises four days a week; attends Phase IV Cardiac Rehab; no longer smokes; watches his diet more closely; and has gone from 60 to 70-hour work weeks to 35-hour work weeks.  he has lowered his total cholesterol from a high of 300 to a low of 150.  he release his pent-up energy and frustration on the golf course.  Since his bypass surgery 16 years ago, he has undergone two cardiac catheterization procedures to open blocked arteries. 

"Before heart disease, I had a good life but I took it for granted," Joe said.  "Now, I take time to smell the roses." 

-- by Linda Barlow, Genesis 

Symptoms of Depression
*  Persistent sad, anxious, or "empty" mood
*  Feelings of hopelessness, pessimism 
*  Feelings of guilt, worthlessness, helplessness
*  Los of interest or pleasure in hobbies and activities you once enjoyed 
*  Decreased energy, fatigue, being "slowed down" 
*  Difficulty concentrating, remembering, making decisions 
*  Insomnia, early-morning awakening, or oversleeping 
*  Appetite and/or weight changes 
*  Thoughts of death or suicide, or suicide attempts
*  Restlessness, irritability 

Seek an evaluation for depression if five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life.  

-- Source:  National Institute of Mental Health