DEPRESSION, STRESS AND CARDIAC DISEASE

Victor Bloom MD

Having just undergone a cardiac screening since I am technically a 'cardiac-risk,' and coming out OK, I started reviewing in my mind all the factors which I have learned add to cardiac risk, including emotional stress. The latest research indicates beyond a shadow of a doubt that depression in men leads to an increased rate of cardiac deaths and shortened longevity. For some strange reason depression in women does not lead to an increased incidence of cardiac deaths.

So men take heed--- especially men in their later years. Just being old increases the chance of cardiac problems; they accumulate with age, due to aging heart muscle and less flexible vessels. The trick is to make the most of our remaining years, and the cardiologists emphasize diet and exercise, which is included under the caption--- 'lifestyle'. We are implored to make lifestyle changes, and these include such items as stopping smoking and curtailing alcohol excess. It is also very important to give up being sedentary. This admonition is especially hard to follow if there is significant arthritis in the legs. One may need to find the right painkillers or undertake orthopedic surgery to get new joints.

The heart specialists used to encourage vigorous aerobic exercise on a regular basis, but now recommend all sorts of moderate and even minimal exercise, such as walking and swimming, with relatively short spells of using the treadmill or bicycle. They suggest starting with 15 minutes of mild exercise each day, which should not be too much of a burden. My idea of mild exercise is mock bandleading or orchestra conducting to favorite music.

If the blood pressure is high, it should be reduced with appropriate medication, as high blood pressure overworks the heart muscle and predisposes to stroke. If the cholesterol is high, that can be reduced by appropriate dietary restrictions and/or the use of lipid-reducing medications. Hopefully the HDL, the good cholesterol is high, and the LDL, the bad cholesterol is low. It's a good idea to get them checked.

Whatever the person can do to lose weight is to the heart's advantage. Losing weight can be accomplished by eating and exercising moderately. Lifestyle changes do not occur if the perception of them is too painful or seems too extreme. People don't like to feel deprived.

We are learning more and more about the deleterious effect of emotional stress on physical health and longevity. People with depression are under emotional stress, even if it doesn't show, even if it seems that the external environment seems calm. Inner turmoil is often hidden. Strong emotions are contained rather than expressed. The suppression of emotional expression leads to an inner 'pressure-cooker' where people feel worried about losing their tempers or blowing their tops. Pent up anger can lead not only to high blood pressure, but to a vicious cycle of lowered self esteem, anxiety and guilt. If the feelings don't come out in some way, they will turn inward and lead to self-hate.

Most often, outward expression of irrational feelings are inappropriate in everyday society. It helps to have a good friend to talk to, someone you admire and respect, with whom you have trust and in whom you can confide. Sometimes people let off steam in the confines of their cars, yelling their outrage out loud. In the absence of these outlets, it is advantageous to find a professional counselor.

Older men especially need someone to talk to. They are often excruciatingly aware of the loss of their youthful powers, and silently grieve the loss of them, of lost opportunities and maybe lost loves. People do die of a broken heart, but broken hearts can be mended and hearts can be healed. Talking helps. Sharing helps. Getting hugged helps. People often find they are not so alone as they think.

I have written about the external pace of life, a pace that is in itself stressful. People do need to slow down and relax, whether by sitting in a park, reading a book or simply listening to music or the natural ambient sounds. People need to heed the warning signals of the body, and not ignore them.

So take good care of yourself and it will pay off in happier years. This is your life and this is the time of your life. Enjoy it while you can. Enjoyment of life will be more possible if you are in good physical and mental health.

Dr Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a member of the American Academy of Psychoanalysis and on the editorial board of the Wayne County Medical Society. He welcomes comments at his email address--- vbloom@comcast.net.