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Heavy burden: Heart failure is often accompanied by depression
The quality of life for people suffering from heart failure is often severely restricted. The physical complaints are often accompanied by psychological problems such as depression. Because of the heart disease, many of these patients need to be treated differently from depressed people 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. Among other things, this leads to shortness of breath, decreased performance, fatigue and water retention in the legs. This massively limits the quality of life for many of those affected. In addition, this heart disease is often accompanied by psychological problems.
In addition to the physical complaints, there are psychological problems
Like the heart specialist Prof. Dr. med. Thomas Meinertz from the Scientific Advisory Board of the German Heart Foundation explains in a message that the physical complaints in heart failure patients "are often accompanied by psychological problems such as depression, anxiety and reduced mental performance."
"At least a quarter of patients with heart failure have not only depressive but also anxious symptoms," said the expert.
The problem is that classic antidepressants are often unsuitable or less effective in patients with heart failure than in depressed people without physical limitations.
Some antidepressants are unsuitable for heart patients
Antidepressants work well for many heart-healthy people with depression, but:
"If there is a heart failure, it is particularly critical to check whether antidepressants should be taken," emphasizes heart specialist Prof. Stefan Störk, head of clinical research at the German Center for Heart Failure (DZHI) at the University Hospital in Würzburg.
In particular, the so-called tricyclic antidepressants should therefore be avoided as far as possible due to vegetative side effects, the risk of cardiac arrhythmias and an increase in the frequency of infarction in cardiac patients.
So-called selective serotonin reuptake inhibitors (SSRIs) are better tolerated, but they can have adverse interactions with some heart medications.
In addition, recent studies comparing SSRIs to a dummy medication have shown that SSRIs do not alleviate depressive symptoms in many patients with symptomatic heart failure, as with other chronic physical illnesses (e.g. the kidney).
Sports and psychotherapy for depression
According to the experts, it has not yet been finally investigated why antidepressants seem to work worse in heart failure patients than in healthy people.
It is possible that the causes of depression in severe chronic diseases such as heart failure are different than in physically healthy people.
According to the Heart Foundation, there are still good options 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. Christiane E. Angermann from the DZHI.
"Through cognitive behavior therapy, negative thinking patterns and attitudes as well as deficits in perception can be reduced in conversation with the therapist."
Exercise also helps against depression. Regular endurance training is especially recommended here, according to experts.
Physical training improves blood circulation in the brain and muscles 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 recognized early.
This in turn can have a negative effect on heart weakness, because depressed people often do not follow therapy recommendations as closely, often eat unreasonably or do not exercise enough.
It is therefore all the more important that doctors and patients pay special attention to accompanying psychological symptoms. According to the experts, the main symptoms of depression are:
- Persistent depressed mood
- loss of interest, joylessness
- lack of drive
- Increased fatigue
In addition, other symptoms such as insomnia, decreased concentration or feelings of guilt can occur.
Nevertheless, the depression can easily be overlooked by doctors and even those affected, because the heart disease itself is accompanied by similar symptoms, namely fatigue, difficulty concentrating, lack of drive and often also sleep disorders.
The earlier depression is recognized and the complex interactions with cardiac insufficiency are taken into account in the treatment according to the individual needs of each patient, the better are the chances of becoming healthier and more productive and regaining more quality of life. (ad)