Stress, Depression and Anxiety


How Stress Affects Your Heart

In situations that are perceived as stressful, your body reacts by releasing stress hormones. In response, your heart rate and blood pressure increase, your breathing becomes faster and more shallow, your skin starts to sweat, and your entire body revs up into high gear.

In the short term, these reactions make you more alert and able to deal with the stressful situation. But if you are under stress for a long time, other changes occur:

  • Fat cells that were released into the bloodstream for extra energy become converted into cholesterol
  • Platelets circulating in the blood become more “sticky”
  • Patterns of daily life may change, making it more difficult to eat well, exercise regularly, and get enough rest

How to Manage Your Stress

How we think about an event determines its impact on our health.

  • Attend a stress management program (see below) and learn how to:
    • Identify what causes you stress and how it affects you
    • Learn stress management skills like breathing and relaxation exercises
  • Be physically active every day to help reduce the effects of stress
  • Identify and use your support networks (e.g., friends and family)
  • Get a “Coping with Stress” booklet from the Prevention & Wellness Centre and read a book about stress management
  • If you feel overwhelmed or if you are having difficulty functioning in your daily activities, speak to your doctor or nurse about options available to help you (e.g., books, websites or a referral to counselling services).

More Information about Stress

Stress Management Program

The University of Ottawa Heart Institute Minto Prevention and Rehabilitation Centre provides a skills-oriented Stress Management Program that offers a variety of techniques to better manage stress. There are five 90-minute sessions in a group format and each of the sessions covers different topics including:

  • Breathing and muscle relaxation techniques
  • Improving assertive communication
  • Uncovering and changing negative thoughts
  • Using humour as a coping strategy

Location: University of Ottawa Heart Institute, 40 Ruskin St., Ottawa
To Register: Call 613-696-7399
Material Cost: $30

Family members can access the Stress Management Program through the Prevention & Wellness Centre after a cardiac risk assessment.


  • Don’t Sweat the Small Stuff…and It’s All Small Stuff, R. Carlson
  • Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness, J. Kabat-Zinn
  • Stress, Sanity and Survival, R.Woolfolk, FC Richardson
  • The Relaxation & Stress Reduction Workbook, M. Davis, M. McKay and E. Robbins-Eshelman


Depression is common in people with heart problems. About one in five patients (20%) experience clinical (or major) depression. If you are feeling at least five of the symptoms listed below for a two-week period or more, you may be developing depression and you may need to speak to your doctor or nurse.

These symptoms may include:

  • Sad feelings
  • Loss of interest in activities that you usually enjoy
  • Changes in appetite
  • Significant unplanned weight loss or weight gain
  • Sleep problems
  • Loss of energy
  • Difficulties with concentration or memory
  • Decrease in your normal social activities or withdrawing from friends and family
  • Feelings of worthlessness, helplessness, or hopelessness
  • Changes in sexual desire
  • Thoughts about death or suicide

How Depression Affects Your Heart

Depression may affect your heart in two ways: directly and indirectly. Depression affects your heart directly by increasing the risk of blood clotting, plaque build up and atherosclerosis. Depression also negatively affects your immune system, so you are less able to fight off germs and viruses.

Depression may affect your heart indirectly by influencing some of the decisions you make. People with depression often find it difficult to make healthy choices about quitting smoking, exercising, eating, or taking medications safely. They find it difficult to find the drive or energy to make healthy lifestyle changes.

What You Can Do If You Are Feeling Depressed

  • Negative thinking is often involved in depression. Getting help to learn new ways of thinking and stopping the negative thinking can be beneficial.
  • Do more pleasant activities—even if you don’t feel like it.
  • Exercise regularly. Getting out for a walk everyday may improve your mood.
  • Set realistic goals and do one thing at a time.
  • Celebrate your achievements. You may need to record your daily activities to prove to yourself that you are making gains.
  • Take time for yourself.
  • Talk about your problems or concerns; don’t bottle up your feelings.
  • Seek support from your family and friends and/or from support groups.
  • Participate in the Cardiac Rehabilitation Program.
  • Talk to your doctor or a mental health professional (social worker, psychologist, or psychiatrist) about proven treatments for depression.

More Information about Depression


  • Feeling Good: The New Mood Therapy, Burns, D. (1990)
  • Mind Over Mood: Change How You Feel by Changing the Way You Think, Greenberger & Padesky (1995)

Web Sites


Anxiety is one of the most distressing emotions that people feel. At some point in time, most cardiac patients will experience varying degrees of fear or nervousness related to their health condition.

Anxiety describes a number of problems including generalized anxiety (a mixture of worries experienced most of the time), panic attacks (intense feelings of anxiety which people often feel like they are going to die), and posttraumatic stress disorder (repeated memories of terrible experiences with high levels of fear).

Like depression, about one in five cardiac patients experience significant anxiety symptoms. These symptoms may include:

  • Uncontrollable worry
  • Feeling “on edge” or restless
  • Feeling irritable
  • Muscle tension
  • Light-headedness
  • Sleep problems
  • Being easily fatigued
  • Difficulty breathing
  • Increased heart rate
  • Headaches
  • Sweating
  • Gastrointestinal (stomach) problems

How Anxiety Affects Your Heart

Anxiety may play a role in cardiac problems by increasing the risk of an irregular heart beat and triggering spasms; both of these responses may lead to cardiac complications. Anxiety may also lead to unhealthy behaviours such as: smoking, overeating, poor sleep and decreased physical activity.

What You Can Do If You Are Feeling Anxious

Learn to recognize when you are starting to feel anxious and plan ways to manage your feelings, for example:

  • Learn new coping strategies to cope with anxious situations instead of avoiding them.
    • Practise slow and deep breathing
    • Imagine scenes that are relaxing and pleasant for you
    • Learn relaxation skills (e.g., tense and release the muscles throughout your body)
    • Distract yourself from the thoughts or physical symptoms that contribute to your anxiety (e.g., count backwards from 100 in three’s)
    • Do something pleasurable like reading a funny book of getting a back rub
    • Share your fears and worries with someone you  trust
  • Challenge yourself to change the way you are thinking about a problem. For example, tell yourself “I can handle this, I’ve done  it before” or “I’m not going to die, it is normal for my heart to pump harder when  I am exercising”.
  • Prepare solutions to problems that cause you anxiety, so you are ready in advance.
  • Determine how much control you have in a given situation and let go of things that are beyond your control.
  • Talk to your doctor or a mental health professional (social worker, psychologist, or psychiatrist) about proven treatments for anxiety.
  • Participate in the Cardiac Rehabilitation Program.

More Information about Anxiety


  • The Anxiety and Phobia Workbook (4th Ed.), Bourne, E. (2005)

Web Sites