Heart, brain and mood

Your heart and your mood are closely linked. Long-lasting stress, depression and anxiety can strain the heart and blood vessels. And a heart attack, a stroke or heart failure can lead to depression, fear and trauma symptoms. Each problem can make the other worse.

Midlife is when many people first learn they have high blood pressure, high cholesterol or heart disease. It is also a time of heavy stress for many. This guide explains how the heart and mind affect each other, what the research shows, and what you can do. It is part of our midlife guide.

Signs to watch for

Depression and anxiety can look different when the heart is involved. People often blame the feelings on the illness or on getting older. Watch for these signs lasting two weeks or more:¹¹

• Feeling sad, empty, hopeless or worthless most days
• Losing interest in things you used to enjoy
• Feeling tired or slowed down, or restless and irritable
• Trouble sleeping, or sleeping much more than usual
• Changes in appetite or weight
• Trouble thinking, remembering or making decisions
• Thoughts of death or suicide

After a heart event, many people also feel constant worry about another attack, avoid activity out of fear, or have flashbacks and nightmares. These can be signs of anxiety or post-traumatic stress.⁵ You can take our free depression test to see whether talking with a professional makes sense.

How the mind affects the heart

When stress, depression or anxiety last a long time, the body stays on alert. The CDC describes these effects:¹

• Higher heart rate and blood pressure
• Less blood flow to the heart
• Higher levels of cortisol (a stress hormone)
• Over time, these changes may add to calcium buildup in the arteries, metabolic disease and heart disease

Depression is also linked to more inflammation and to blood platelets clumping together, which can help form clots.⁴

Behavior matters too. People who are depressed or anxious are more likely to smoke, be less active and miss doses of their medicines.¹ It is hard to cook healthy meals or go for a walk when you have no energy or hope.

What the numbers show. Researchers looked at U.S. national health survey data from 2005 to 2018. Among adults aged 40 to 79, the estimated 10-year risk of heart disease or stroke was higher in people with depression.² For women, risk rose from about 6.0% with no depression to 7.6% with major depression. For men, it rose from about 9.9% to 11.3%.² Even mild depression was linked to higher risk. This kind of study cannot prove depression causes heart disease, but it shows the two often go together.²

Loneliness also plays a part. An American Heart Association report found that social isolation and loneliness were linked to about 29% higher risk of heart attack or death from heart disease, and 32% higher risk of stroke.⁹ See our guide on divorce, empty nest and loneliness.

How the heart affects the mind

A heart attack, stroke or heart failure is a shock. Pain, fear of dying or disability, and money worries can all lead to depression, anxiety or PTSD.¹

Experts report that these problems are common:⁵

• About 1 in 8 heart attack survivors develops post-traumatic stress.
• After heart bypass surgery, 30% to 40% of people have depression or anxiety.
• After a cardiac arrest, about a third have PTSD symptoms.

Depression can make recovery harder. People with depression recover more slowly after heart surgery and have a harder time finishing cardiac rehab.⁵ A depression diagnosis at any time after heart disease is found doubles the risk of early death.⁴ That is why the American Heart Association recommends treating depression as a risk factor after a heart attack.⁴

Depression after a heart event does not always last. It can pass, especially in younger people, or it can come back.⁴ Either way, it deserves attention.

What helps

Steps you can take

1. Ask for a mood check. After any heart attack, stroke, heart surgery or new heart diagnosis, ask your doctor to screen you for depression and anxiety.³
2. Say yes to cardiac rehab if it is offered. Ask about the counseling part too.⁸
3. Move a little every day. Start small. A short walk counts. Our walking plan and exercise for mood pages can help you build up safely, with your doctor's OK.
4. Do one small thing you used to enjoy. Getting dressed, eating breakfast or calling a friend are good starts after a heart event.⁵ Our behavioral activation lessons show how.
5. Calm your stress response. Try a slow breathing practice like the cyclic sigh or box breathing.
6. Keep a list of all your medicines and bring it to every visit. Mood and heart medicines can interact.⁷
7. Watch your alcohol. Long-term heavy drinking harms the heart. See alcohol in midlife.

For partners, family and friends

A heart event affects the whole family. In some studies, family members of cardiac arrest survivors reported even more distress than the survivors themselves.⁵ If you are the main helper, look after your own sleep, meals and support.

Ways to help:

• Ask how they are feeling, and listen without rushing to fix things.
• Notice withdrawal, irritability or loss of interest. These can be depression, not just tiredness.
• Encourage cardiac rehab and follow-up visits. Offer rides if that helps.
• Go for walks together.
• Learn the heart attack warning signs (below) and call 911 without delay.

Our guide on helping someone with depression has more ideas. If you also care for a parent, see caregiving in midlife.

Special situations

Women. PTSD and depression are linked to higher rates of coronary heart disease and death from it in women.¹ Women's heart attack symptoms can also include anxiety, nausea, shortness of breath and unusual tiredness, along with chest discomfort.¹⁰

Veterans and people with PTSD. Veterans have a higher risk of heart disease, mainly linked to combat-related PTSD.¹ See PTSD in older adults and veterans.

After a stroke. Depression is common after a stroke. Treating it can help recovery of the body and the mind.¹¹ Our page on depression with heart disease, stroke, diabetes and pain covers this in detail.

Mental health medicines and the heart. Some antipsychotic medicines are linked to weight gain, diabetes and heart problems.¹ Ask your doctor how your medicines affect your heart, and never stop a medicine on your own.

Common questions

Can stress really cause a heart attack?

Long-term stress raises blood pressure, heart rate and stress hormones, and it makes healthy habits harder.¹ These effects add to heart disease over time. Stress is one piece of the picture, along with blood pressure, cholesterol, smoking, diabetes and family history.

Is it normal to feel down after a heart attack?

Many people feel sad, scared or shaken. That is common. If the feelings last more than two weeks or get in the way of daily life, talk with your doctor. It may be depression, and it can be treated.^7,11

Are antidepressants safe if I have heart disease?

Many people with heart disease take antidepressants. Your doctor will choose one that fits your heart condition and other medicines.⁶ Talk with your doctor or pharmacist before starting, stopping or changing any medicine.

Does feeling positive help the heart?

Research links optimism with a lower risk of heart disease and stroke, and a sense of purpose with healthier habits.³ These are links, not proof. They suggest caring for your mind is part of caring for your heart.

When to get help

See your doctor if low mood, worry or loss of interest lasts more than two weeks, or if fear is keeping you from rehab or daily life.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.