Depression, Anxiety and Heart Disease
Coping with Chronic Illness
How Depression and Anxiety Affect Diabetes
NCPA Publications on Mind-Body Issues
The Role of the School Nurse
Our Site by Key Words
Your Mind and Your Heart
How Depression and Anxiety Can Have a Major Impact on Heart Disease
Carol E. Watkins, MD
most people are aware that psychological factors can have powerful detrimental
or protective effects on the development and progression of cardiovascular
disease (heart attacks, strokes and high blood pressure). In the 1950s,
researchers described individuals with a "Type A" personality who were more
likely to have cardiovascular disease than those with the more laid-back "Type
B" personality. The classic definition of "Type A" includes impatience, an
aggressive attitude, a sense of time urgency and competitiveness. Since then,
research has further refined and expanded our understanding of the relationship
between emotions and heart disease. Hostility as well as conflicts about
expressing oneís anger may have more specific predictive value.
Anxiety or other stress may be
associated with an increased rate of sudden cardiac events. Individuals who are
more isolated or who are over-worked are more likely to develop heart problems.
Stress can lead first to intermittent and then to constant high blood pressure.
Mental stress has been shown to cause decreased blood flow to the heart. If an
individual with cardiac disease is depressed, he or she is much more likely to
have a subsequent heart attack.
If an individual with cardiac
problems or high blood pressure has depression, anxiety or a "Type A"
personality, psychiatric treatment may be a lifesaver. Some researchers suggest
that it is critical for all cardiac patients to be carefully evaluated for
depression. If depression is present, it should be treated carefully and
completely. Hypnosis, relaxation, and other anxiety-reduction techniques can
reduce blood pressure and reduce cardiac risk. "Type A" individuals may benefit
from psychotherapy to help them modify their personality style. Family or
couples therapy may reduce interpersonal sources of stress. Some individuals
with cardiac disease may need medication to relieve their anxiety or depression.
Now we have newer antidepressant and anti-anxiety medications that are easier
and safer to use in individuals with cardiac disease.
Many individuals experience a heart
attack as a "wake-up call." They re-evaluate their lives and relationships. The
crisis becomes an invitation to finally deal with long-standing depression,
anger and anxiety.
Carol Watkins, MD
Chronic Illness and Living a Full Life
Glenn Brynes, PhD, MD
Most of us go through our lives with
only limited medical problems. We take for granted our good health and our
freedom from chronic pain. We live in an invisible bubble that seems to protect
us from the pain and suffering that others may have. We think, "It won't happen
That protective bubble bursts when we
experience a serious or chronic illness. Joints that used to ache only after
unusual exertions, now hurt daily and worsen after even moderate exercise. We
are shocked, and we begin to worry about our ability to do the things we have
always done and enjoyed. We feel sad at the possibility of losing our favorite
activities. Dealing with this requires a change in self-image. A tennis pro with
a back problems may feel a big loss even if she can still play a more sedate
Feeling sad, angry or worried is
understandable. How can we deal with this loss? The coping process may involve
reorganizing the self-concept and taking stock of what we still can do. Are
there other activities that can fill the void?
This process becomes easier if we
believe that the most important part of ourselves is still intact. Strong
self-esteem and spiritual beliefs are helpful. As with any loss, a period of
mourning is normal. This permits recognition of, and gradual acceptance of the
loss. This can free our energies for re-investment in new activities. This is
not a time for lengthy periods of self-pity. The sadness of mourning can be a
way-station, but dwelling there too long can undercut our self-image. We need to
re-channel our energies toward things we can still do and enjoy. This often
means learning new skills, or pursuing activities we mastered in the past but
put aside. A model ship builder with failing vision, might start writing about
the ships he loves.
Adapting to a chronic illness is not
the same as lowering our expectations for ourselves. Coping is a dynamic process
that continues to challenge our tolerance, strength and creativity. Although the
illness or physical limitation will probably continue to be frustrating, and
sometimes burdensome, it does not need to devastate us or break our spirits.
Scientific Interests In The Mind-Body Interface
"Depression and Anxiety in the Person with Diabetes" Watkins, CE
Practical Diabetology December 1998.
This article reviews research
on the relationship between depression, anxiety and diabetic control. Both
depression and anxiety are associated with poorer diabetic management. When
either condition is treated, the diabetic control improves. Certain
antidepressants can raise blood glucose and others can lower it. This should be
taken into consideration when treating an individual with depression and
"Recognition of Anxiety and Depression By Residents in a General Medicine
Clinic" by Walker, Novack, Brynes and Kaiser , Journal of Medical Education,
This research found that about a quarter of patients presenting to a general
medical clinic were depressed. The physicians (medical residents) had difficulty
identifying depressed patients. Since the patients themselves were more aware of
the depression, it highlighted the importance of asking patients about
depression during general medical visits.
Who Is That
Person In The Health Suite, And What Does She (or He) Really Do?
Carol Watkins, MD
The school nurse is a pretty
busy person. She usually does a number of different things as part of her job.
She is often the first medical person to see you if you get sick or hurt at
school. Most people have met her when they got hit too hard by a baseball or had
a cut or scrape. For this kind of thing, she may fix it up and send you back to
class. If it is a fever or the flu, she takes care of you until your parents get
there. Occasionally, someone has a bad accident or gets seriously ill at school.
Then you really see her in action. She arranges for an ambulance or other
emergency help and may start emergency medical care. Hopefully it will never
happen, but it is nice to know that she can handle that sort of thing.
Some students need to take medicine at school. Unless you have special
permission, donít carry medicine around school in your pocket! People are very
concerned about the issue of illegal drugs and you donít want anyone getting the
wrong idea! The nurse or an assistant should keep the medicine and give it to
you at the right time. Some people really like that daily visit and the nurse
gets to be a special friend. Other students are embarrassed. They worry that
people will find out about the medicines and will laugh at them. Letís face
itósome people can be rude or even cruel. If this worries you, talk to your
doctor and to the school nurse. Between them, they may be able to figure a way
to get around the problem.
Students with diabetes, asthma or other medical problems may get more intensive
help from the nurse.
Occasionally, a student likes the health suite too much. Then the nurse may have
to be firm and send him back to class.
A student may have a medical problem and be afraid to tell his or her parents.
The nurse can often help you find a way to talk to your parents or your doctor.