Mental Health and Heart Disease

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By C. Britt Peterson, MD, MPH, Psychiatric Physician with Mission Health

Is there a relationship between mental health and heart health? We do know mental health conditions often cause behavioral changes that make it harder to participate in follow-up care, stay on medications and engage in the lifestyle changes that are vital for the prevention of and recovery from heart disease.

However, we also know there are important biological factors. Many mental health conditions are associated with increased stress hormone production, inflammation and clotting abnormalities that can also increase the risk of cardiac events or heart disease. According to the Depression and Bipolar Support Alliance, cardiovascular disease can cause harm to the areas of the brain that contribute to the development of mental health problems.

Clinical depression is important to recognize and treat. This is a condition that leads not just to sadness, but multiple symptoms affecting functioning such as enjoying things less, and changes in sleep, concentration or energy. In some cases, it can also lead to suicidal thoughts and behaviors.

According to the American Heart Association, depression is surprisingly common among those who have had a heart attack or heart surgery (approximately 1 in 3 people). A recent study published in Circulation, “Cardiovascular Quality and Outcomes,” said that despite its frequency, depression, after a cardiac event, should never be ignored, as people with depression, have an increased risk of death (approximately 50 percent higher) over 30 months than those who don’t have depression.

Other mental health conditions particularly relevant to heart disease are generalized anxiety disorder, panic disorder and post-traumatic stress disorder. A 2010 article in the Journal of the American College of Cardiology highlights that although these conditions can cause physical anxiety symptoms that mimic heart disease, there is an actual increased risk of heart disease (25 percent higher) and death from heart disease (50 percent higher) in these conditions that should not be dismissed in regards to evaluating physical concerns. Even if anxiety symptoms are the cause of chest discomfort, one should seek mental health treatment to at least minimize the risk of future heart problems.

As cardiovascular disease is the leading cause of death in our nation, psychiatric physicians like me and other mental health professionals have an important role in the prevention and care of heart disease. We need to work more closely with other healthcare providers, including those in primary care and cardiology. You, as the patient, should not be afraid to ask for our help, and even demand that we work as an integrated part of your overall healthcare team. By being an advocate, you can not only save and improve the quality of your own life but for many other people as well.

Dr. Britt Peterson is a psychiatrist with Mission Health. If you are experiencing signs of depression, anxiety disorder, panic disorder or post-traumatic stress disorder, please speak with your primary care provider. For more information on heart health, please visit

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