Heavy Load Depression is often associated with heart failure

Heavy load: Heart failure is often associated with depression

In people who suffer from heart failure, the quality of life is often severely limited. The physical symptoms are often accompanied by psychological problems such as depression. Because of heart disease, many of these patients need to be treated differently than those without physical limitations. Experts explain what can help those affected.

Over three million heart failure patients in Germany

According to health experts, more than three million people in Germany suffer from heart failure (heart failure). As a result of this disease, the heart is no longer able to provide the body with sufficient blood and oxygen. This leads among other things to shortness of breath, decrease in performance, fatigue and water retention in the legs. As a result, the quality of life is massively limited for many people affected. In addition, this heart disease is often associated with mental health problems.

For many heart failure patients come to the physical symptoms and mental problems such as depression. Experts explain how sufferers can be treated. (Image: pololia / fotolia.com)

To the physical complaints come mental problems

Like the cardiologist Prof. Dr. med. med. Thomas Meinertz of the Scientific Advisory Board of the German Heart Foundation stated in a statement, "often psychological problems such as depression, anxiety and decreased mental performance are added to the physical complaints in heart failure patients."

"At least a quarter of patients with heart failure have not only depressive but also anxious symptoms," says the expert.

The problem is that classical antidepressants are often inappropriate or less effective in patients with heart failure than in those with no physical limitations.

Some antidepressants are unsuitable for cardiac patients

Although antidepressants are well-effective in many heart-healthy people with depression,

"If there is heart failure, it is particularly critical to examine whether antidepressants should be taken," emphasizes cardiologist Prof. Dr. med. med. Stefan Störk, Head of Clinical Research at the German Center for Heart Failure (DZHI) at the University Hospital Würzburg.

Especially the so-called tricyclic antidepressants should therefore be avoided as far as possible because of vegetative side effects and the risk of cardiac arrhythmia and an increase in infarct frequency in heart disease.

Although so-called selective serotonin reuptake inhibitors (SSRIs) are better tolerated, they may have unfavorable interactions with some heart medications.

In addition, recent studies comparing SSRIs with a dummy treatment have shown that SSRIs in many patients with symptomatic heart failure - as well as other chronic physical conditions (eg kidney) - do not alleviate depressive symptoms.

Sports and psychotherapy for depression

According to the experts, it has not yet been conclusively explored why antidepressants appear to be worse in heart failure patients than in heart health.

It is possible that the causes of depression in severe chronic diseases such as heart failure are different to those of physically healthy people.

According to the Heart Foundation, there are still good opportunities for patients with heart failure to treat the depressive symptoms.

"Psychotherapy, especially cognitive behavior therapy in combination with regular physical activity, can often improve both the mood and the quality of life of cardiac patients," explains cardiologist Prof. Dr. med. med. Christiane E. Angermann from the DZHI.

"Through the cognitive behavioral therapy can be broken down in conversation with the therapist negative thinking patterns and attitudes as well as deficits in the perception."

Sport also helps against depression. Above all, regular endurance training is recommended here according to experts.

Physical training improves the blood circulation in the brain and musculature and thereby strengthens the physical and mental performance of cardiac patients.

"All of this also has a positive effect on depression and its symptoms, such as reduced ability to concentrate and insomnia," says Angermann.

Depression is not always recognized early
According to the Heart Foundation, depression in heart patients is not always detected early.

This in turn can have a negative effect on the heart failure, because depressives often hold less accurate therapy recommendations, eat often unreasonable or move too little.

Therefore, it is all the more important that doctors and patients pay particular attention to psychologically associated accompanying symptoms. According to the experts, the main symptoms of depression are:

- Persistently depressed, depressed mood
- Loss of interest, joylessness
- lack of drive
- Increased fatigue

In addition, other symptoms such as insomnia, decreased concentration or guilt may occur.

Nevertheless, the depression can easily be overlooked by physicians and even those affected, because even the heart disease itself is associated with similar symptoms, namely fatigue, difficulty concentrating, listlessness and often also sleep disorders.

The sooner depression is recognized and the complex heart failure interactions are considered in the treatment according to the individual needs of each patient, the better the chances of getting healthier and more efficient and regaining a better quality of life. (Ad)