Why Your Psychiatrist Should Care About Your Heart (And Why I Do)

The Question That Changed How I Practice

A few years ago, a patient named Sarah* came to see me for depression. She was 42, exhausted all the time, and told me she felt like she was “just going through the motions.” We talked about her mood, her sleep, her relationships—all the things you’d expect in a psychiatric evaluation.

Then, almost as an afterthought, she mentioned: “Oh, and my dad died of a heart attack at 48.”

I stopped writing notes and looked up. “Tell me more about that.”

Her father had struggled with depression for years before his heart attack. Her grandfather had died of heart disease at 52. Her uncle had bypass surgery at 50. But here’s the thing—no one had ever connected the dots between her family’s mental health struggles and their heart disease.

That conversation was one of many that changed how I practice psychiatry. Because your mental health and your heart health aren’t separate issues that happen to exist in the same body. They’re deeply, biologically, inseparably connected.

And if I’m going to help you feel better and live a long, healthy life, I need to pay attention to both.

*Name and details changed to protect privacy

What Most People Don’t Know (But Should)

Here’s something that might surprise you: if you have depression, your risk of having a heart attack goes up by 28%, and your risk of dying from heart disease increases by 44%.

Let me put that in perspective. That’s about the same level of risk you’d get from:

• Smoking
• Having high cholesterol
• Having high blood pressure

Would you expect your doctor to ignore it if you smoked? Or if your cholesterol was through the roof? Of course not. So why would we ignore depression’s effect on your heart?

The research on this is crystal clear. We’re talking about studies involving hundreds of thousands of people, followed for years, published in the most prestigious medical journals. The American Heart Association and American College of Cardiology—the organizations that write the rules for heart doctors—now tell cardiologists to screen their patients for depression and treat it.

If heart doctors are being told to care about depression, shouldn’t psychiatrists care about heart disease?

I think so. That’s why I do.

The Vicious Cycle Nobody Talks About

Here’s how this typically plays out, and maybe you’ll recognize yourself in this story:

You’ve been struggling with depression or anxiety. Maybe for months, maybe for years. You’re tired all the time. Exercise sounds impossible. You’re not sleeping well. You’re stressed about work, money, relationships—or all of the above.

Meanwhile, quietly, invisibly, your body is responding:

• Your inflammation levels are rising
• Your stress hormones are elevated
• Your blood pressure might be creeping up
• Your heart rate variability (a measure of heart health) is decreasing
• You’re not moving as much, not eating as well

All of this increases your risk of heart disease. But nobody’s mentioned it because you’re young, or your basic cholesterol test looked “fine,” or because heart disease seems like something for “old people” to worry about.

Then, years later—maybe after a heart attack, maybe just at a routine physical—someone finally checks your heart health more thoroughly. And suddenly you’re dealing with cardiovascular disease on top of your mental health struggles.

Here’s the really frustrating part: the heart disease makes your depression worse. Heart disease increases inflammation, limits what you can do physically, adds stress and worry, and can affect blood flow to your brain. So now you’re caught in a cycle where each condition makes the other one harder to manage.

I’ve watched this happen too many times. And I decided I wasn’t going to let it happen to my patients if I could help it.

The Science Part (I Promise to Keep It Simple)

You might be thinking: Okay, but HOW does depression affect my heart? This sounds like pseudoscience.

I get it. I’m a psychiatrist, so I love the science. But I’ll keep this brief and actually understandable.

The Inflammation Story

Think of inflammation like your body’s fire department. When you get a cut or an infection, inflammation rushes to the scene to help you heal. That’s good inflammation.

But with depression, it’s like the fire alarm gets stuck and won’t turn off. Your body stays in a state of chronic inflammation, and that inflammation doesn’t just stay in your brain—it affects your entire cardiovascular system.

This chronic inflammation:

• Damages the lining of your blood vessels
• Makes plaque build-up more likely
• Increases your risk of blood clots
• Contributes to heart attacks and strokes

Here’s what really got my attention as a psychiatrist: research shows that inflammation increases heart disease risk even when cholesterol is perfectly controlled with statins. Published in The Lancet. This tells us that inflammation is its own problem, separate from cholesterol. And guess what often comes with chronic inflammation? Depression and anxiety.

The Stress Hormone Problem

When you’re stressed or anxious, your body releases cortisol and adrenaline. This is your “fight or flight” response, and it’s supposed to help you escape from lions or whatever our ancestors were running from.

The problem is, your body can’t tell the difference between running from a lion and stressing about your job, your health, or your relationships. So if you have chronic depression or anxiety, these stress hormones stay elevated for weeks, months, or years.

Chronically high cortisol levels:

• Raise your blood pressure
• Increase belly fat (the particularly dangerous kind)
• Make your blood vessels stiff and less flexible
• Contribute to insulin resistance and diabetes
• Generally wreak havoc on your cardiovascular system

When I see someone in my office dealing with chronic work stress or anxiety, I’m not just thinking about their emotional state. I’m thinking about what’s happening to their blood vessels.

The Nervous System Highway

Your heart and brain are in constant communication through your nervous system. It’s like a two-way highway with traffic going both directions all the time.

We can measure how well this system is working through something called heart rate variability (HRV)—basically, how much the time between your heartbeats varies from moment to moment. A healthy heart doesn’t beat like a metronome; it varies based on what you’re doing, how you’re breathing, and how you’re feeling.

Depression and anxiety reduce HRV, and low HRV predicts higher risk of heart problems and even sudden cardiac death. But here’s the hopeful part: many treatments for depression—medications, therapy, mindfulness practices—can improve your HRV and potentially protect your heart.

The Lifestyle Cascade

Then there’s the daily reality of living with depression:

• You’re exhausted, so exercise feels impossible
• You’re not sleeping well, which affects everything
• You might be eating more comfort food or forgetting to eat altogether
• It’s harder to remember to take medications (any medications)
• You might be smoking or drinking more to cope
• You’re probably withdrawing from social connections

Every single one of these affects your cardiovascular health. And here’s the kicker: loneliness and social isolation increase heart disease risk about as much as smoking. That’s not a metaphor. That’s what the research shows.

Why This Matters to Me as Your Psychiatrist

I didn’t go to medical school to be the doctor who only looks at one piece of the puzzle. I became a psychiatrist because I wanted to help people feel better and live fuller, healthier lives.

And I can’t do that if I’m only paying attention to your mood while ignoring the fact that your depression is quietly increasing your risk of a heart attack.

What I Actually Do Differently

When you come to see me, I’m going to ask about things that might surprise you:

Family history questions like:

• “Has anyone in your family had a heart attack or stroke? At what age?”
• “Does heart disease run in your family?”
• “Did anyone have high cholesterol or high blood pressure at a young age?”

Physical health questions like:

• “How’s your energy level? Are you more tired than you used to be?”
• “Do you get short of breath doing things that didn’t used to bother you?”
• “How’s your sleep?” (Sleep disorders affect both mental health and heart health)

Lifestyle questions like:

• “How much are you moving your body these days?”
• “What’s your stress level like?”
• “How are your relationships? Do you feel connected to people?”

I’m going to check your blood pressure at every visit. If you’re on certain psychiatric medications, I’m going to monitor how they’re affecting your weight and metabolism.

And for some patients—especially those with moderate to severe depression, family history of heart disease, or multiple risk factors—I’m going to recommend more comprehensive cardiovascular testing.

I’m Not Trying to Be Your Cardiologist

Let me be clear: I’m not trying to replace your primary care doctor or your cardiologist (if you have one). I’m not going to start prescribing blood pressure medications or adjusting your cholesterol meds.

What I AM doing is making sure we have a complete picture of your health so I can:

• Choose psychiatric treatments that might actually protect your heart
• Catch warning signs early
• Help you understand why lifestyle changes matter for both your mood and your heart
• Coordinate your care better with your other doctors
• Make sure nothing falls through the cracks

Think of it like this: If you went to a doctor for knee pain, and they noticed you were limping in a way that would eventually hurt your hip and back, wouldn’t you want them to mention it? That’s what I’m doing—noticing patterns and connections that affect your long-term health.

The Good News (Because There’s Definitely Good News)

Here’s the part that actually makes me excited: when we treat your depression or anxiety effectively, we’re not just helping you feel better emotionally—we’re potentially protecting your cardiovascular system at the same time.

This isn’t wishful thinking. This is based on solid research:

Antidepressants Can Protect Your Heart

A major study called the EsDEPACS trial looked at people who had just had a heart attack and were also depressed. Half got an SSRI antidepressant (escitalopram/Lexapro), and half got a placebo.

The people taking the antidepressant had significantly fewer heart attacks, strokes, and cardiovascular deaths over the next 8 years.

Read that again. The medication didn’t just make them feel better—it actually protected their hearts.

Other large studies found that people whose depression improved with treatment had 30-40% lower risk of developing heart disease, having a stroke, or dying from any cause.

So when I prescribe an SSRI for someone with both depression and cardiovascular risk factors, I’m not just treating their mood. I’m potentially saving their life.

Therapy Helps Your Heart Too

The evidence for therapy is equally strong. Cognitive Behavioral Therapy (CBT) and other evidence-based therapies don’t just improve your mood—they:

• Reduce inflammatory markers in your blood (yes, really)
• Improve heart rate variability
• Lower blood pressure
• Help you build skills for managing stress
• Improve your relationships (which protects your heart)

Research shows that therapy that successfully treats depression is associated with 30-40% lower risk of developing heart disease. The effects are strongest in people under age 60.

Lifestyle Changes Are Medicine

This is where I sound like every doctor ever, but bear with me because it matters:

• Movement matters: Exercise is as effective as medication for mild to moderate depression. It’s also one of the best things you can do for your heart.
• Sleep is non-negotiable: Poor sleep affects both mood and cardiovascular health. We need to fix it.
• What you eat affects how you feel: A Mediterranean-style diet helps both depression and heart health.
• Connection is protective: Strong relationships literally protect your cardiovascular system.

I don’t say these things to overwhelm you or make you feel guilty. I say them because small changes in these areas create compounding benefits for both your mental health and your heart health.

Real Questions from Real Patients

Over the years, I’ve heard these questions many times. Maybe you’re wondering the same things.

“But I’m young. Should I really be worried about heart disease?”

Heart disease develops over decades, and the risk factors often start in your 20s, 30s, and 40s—especially if you’ve been dealing with chronic stress, depression, or anxiety.

The time to pay attention is before you have a problem, not after. And if you have a family history of early heart disease, this becomes even more important.

Think of it like this: you wouldn’t wait until your teeth fell out to start brushing them, right?

“My basic cholesterol test was normal. Doesn’t that mean I’m fine?”

Not necessarily. Basic cholesterol tests miss a lot of important risk factors, including:

• Lipoprotein(a): A genetic risk factor that about 1 in 5 people have
• Inflammation markers: Which are especially relevant if you have depression
• Advanced lipid particles: Not all cholesterol is created equal
• Other metabolic markers: That show early warning signs

It’s like checking if your car has gas but not checking the oil, tire pressure, or brake fluid. You might think everything’s fine when it’s not.

“I’m already overwhelmed. Are you telling me I need to worry about MORE things?”

No. I’m telling you that what we’re already working on—treating your depression or anxiety—is also protecting your heart.

I’m not asking you to add a bunch of extra appointments or become obsessed with your health. I’m asking you to let me look at the full picture so we can work smarter, not harder.

And honestly? For many of my patients, understanding this connection is actually a relief. It validates that their symptoms are real, biological, and treatable.

“What if you find something concerning?”

Then we caught it early, and we have options. That’s always better than finding it later.

And here’s the thing: most of the time, when we find elevated risk factors, we can address them through the things we’re already doing—treating your mental health, improving sleep, making lifestyle changes, and sometimes adding targeted supplements or medications.

Finding something concerning is an opportunity for early intervention, not a crisis.

What This Looks Like in Practice

Let me walk you through what comprehensive care actually looks like:

Initial Evaluation

When you first come to see me, I’ll take a thorough history that includes:

• Your mental health symptoms (obviously)
• Your family history of both mental health and heart disease
• Your personal health history
• Your current symptoms (including energy level, sleep, physical symptoms)
• Your lifestyle (activity, diet, stress, social connections)
• Basic vital signs including blood pressure

When We Might Do More Testing

For some patients, I’ll recommend comprehensive cardiovascular assessment. This typically includes:

• Advanced lipid panel (including Lp(a), particle size, remnant cholesterol)
• Inflammation markers (like high-sensitivity CRP)
• Metabolic markers (hemoglobin A1c, fasting insulin)
• Nutritional status (omega-3 index, vitamin D)
• Sometimes heart rate variability assessment

This is especially important if you have:

• Moderate to severe depression or anxiety
• Family history of early heart disease
• Multiple risk factors (high blood pressure, diabetes, smoking, obesity)
• Treatment-resistant depression
• Unexplained fatigue

Creating Your Treatment Plan

Based on everything we learn, we’ll create a personalized plan that might include:

• Medication: Choosing antidepressants with cardiovascular benefits when appropriate
• Therapy: Evidence-based psychotherapy that helps both mood and heart health
• Lifestyle medicine: Practical strategies for movement, sleep, nutrition, and stress management
• Targeted supplements: When appropriate (omega-3s, plant sterols, etc.)
• Coordination with other providers: Making sure everyone’s on the same page

Ongoing Monitoring

We’ll keep track of:

• How you’re feeling emotionally
• Your cardiovascular risk factors
• Any side effects from medications
• Your progress with lifestyle changes
• Whether our plan is working or needs adjustment

The goal isn’t perfection. The goal is progress and partnership.

A Note on Getting Older (Whether You Want to or Not)

Look, none of us are getting younger. I’m certainly not.

And while I can’t stop time (trust me, I’ve looked into it), I CAN help you age in a way that lets you actually enjoy your life. That means:

• Feeling good emotionally
• Having energy for the things you love
• Maintaining your physical health
• Reducing your risk of heart disease, stroke, and other chronic conditions

Paying attention to the heart-mind connection isn’t about being paranoid or hypochondriacal. It’s about being strategic and proactive so you can live a long, full life.

Because what’s the point of treating your depression if you’re going to die of a heart attack at 55?

(That’s dark. Sorry. But it’s also why I do this work.)

Frequently Asked Questions

Q: Do all psychiatrists check cardiovascular health?

A: Not routinely, no. Traditional psychiatric practice has focused primarily on mental health symptoms. But this is changing as we understand more about the mind-body connection. I’ve made it a priority in my practice because the evidence is too strong to ignore.

Q: Will my insurance cover advanced cardiovascular testing?

A: It depends on your insurance and your specific situation. Many tests are covered when they’re medically indicated (which they often are for patients with depression and cardiovascular risk factors). We can check your coverage and discuss options.

Q: I’m already seeing a cardiologist. Why would I need cardiovascular assessment from you too?

A: That’s great that you have a cardiologist! My role is different—I’m looking at how your mental health and cardiovascular health interact, and I’m choosing psychiatric treatments that support both. I’ll coordinate with your cardiologist to make sure we’re all working together.

Q: What if I can’t afford supplements or special testing?

A: We always work within your budget. Many of the most important interventions—like therapy, lifestyle changes, and choosing the right medication—don’t require extra spending. We’ll prioritize what matters most for your situation.

Q: Can I just treat my depression without worrying about my heart?

A: You can, but you’d be missing an opportunity. The good news is that treating your depression well often protects your heart automatically. I’m just making sure we’re strategic about it and not missing anything important.

Q: How long does it take to see results?

A: For mood improvement, we typically see changes within 4-8 weeks with medication or therapy. For cardiovascular benefits, we’re playing a longer game—reducing risk over months and years. But some benefits (like reduced inflammation and improved HRV) can start showing up within weeks to months.

Q: What if my family doesn’t have heart disease? Do I still need to worry about this?

A: Family history is just one risk factor. Depression itself increases cardiovascular risk regardless of genetics. Plus, many people don’t know their full family history (grandparents might have died young from “unknown” causes that were actually heart disease). Better to assess and know than assume you’re fine.

Q: I’m already on antidepressants. Are they protecting my heart?

A: Some antidepressants, especially SSRIs like escitalopram and sertraline, have shown cardiovascular benefits in research. But it depends on whether your depression is actually improving and whether we’re addressing other risk factors too. We can review your treatment plan together.

Q: What’s the most important thing I can do right now?

A: Keep reading. Learn about this connection. If you’re struggling with depression or anxiety, get help—for your emotional health and your physical health. And if you’re already getting help, make sure your provider is looking at the whole picture, not just one piece.

The Bottom Line

Here’s what I want you to remember:

Your mental health and your heart health are not separate issues. They’re connected through inflammation, stress hormones, nervous system function, and daily behaviors.

Depression increases your heart disease risk significantly—about as much as smoking or high cholesterol.

The good news is that treating depression and anxiety protects your cardiovascular system. SSRIs can reduce heart attacks. Therapy lowers cardiovascular risk. Lifestyle changes help both.

Comprehensive care that addresses both your mental health and cardiovascular wellness gives you the best chance of feeling better and living longer.

As your psychiatrist, I’m not trying to scare you or add more things to your worry list. I’m trying to help you live a long, healthy, vibrant life where you feel good emotionally and physically.

Because you deserve both.

Ready to Take the Next Step?

If you’re struggling with depression or anxiety, especially if heart disease runs in your family or you have other risk factors, I’d love to help.

In my practice, I offer comprehensive integrative psychiatric care that looks at your whole health—not just your mood, but how your mental health, physical health, and lifestyle all work together.

Continue Reading

Want to learn more? Check out these related articles:

• Your Heart and Mind Are Connected: Understanding Mental Health and Cardiovascular Disease (Main Guide)
• The Science Behind the Heart-Mind Connection (Made Simple)
• What Comprehensive Cardiovascular Testing Actually Looks Like
• How SSRIs Can Protect Your Heart (Not Just Your Mood)

References & Research

This article is based on extensive peer-reviewed research, including:

1. Blazoski C, et al. (2025). Mental Health Disorders and the Development of Cardiovascular Disease. The American Journal of Cardiology. [Shows that depression, anxiety, PTSD, and bipolar disorder significantly increase cardiovascular disease risk in large population study]
2. Krittanawong C, et al. (2023). Association of Depression and Cardiovascular Disease. The American Journal of Medicine. 136(9):881-895. [Meta-analysis confirming 28% increased MI risk and 44% increased cardiovascular mortality with depression]
3. Zeng J, et al. (2025). Cardiovascular Diseases and Depression: A Meta-Analysis. Molecular Psychiatry. [Confirms bidirectional relationship between cardiovascular disease and depression]
4. Virani SS, et al. (2023). AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for Chronic Coronary Disease. Journal of the American College of Cardiology. 82(9):833-955. [Official guidelines recommending mental health screening and treatment in cardiac patients]
5. Levine GN, et al. (2021). Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 143(10):e763-e783. [Comprehensive review of mechanisms linking mental health and cardiovascular disease]
6. Kim JM, et al. (2018). Effect of Escitalopram vs Placebo on Long-term Cardiac Outcomes: EsDEPACS Trial. JAMA. 320(4):350-358. [Landmark trial showing SSRIs reduce cardiovascular events in depressed cardiac patients]
7. El Baou C, et al. (2023). Psychological Therapies for Depression and Cardiovascular Risk. European Heart Journal. 44(18):1650-1662. [Large cohort study showing 30-40% lower CVD risk with successful depression treatment]
8. Ridker PM, et al. (2023). Inflammation and Cholesterol as Predictors of Cardiovascular Events. Lancet. 401(10384):1293-1301. [Shows inflammation predicts cardiovascular events independent of cholesterol]
9. Suglia SF, et al. (2018). Childhood and Adolescent Adversity and Cardiometabolic Outcomes: AHA Scientific Statement. Circulation. 137(5):e15-e28. [Documents long-term cardiovascular effects of early life stress]
10. Apostolos A, et al. (2025). Depression and Coronary Artery Disease—Where We Stand? Journal of Clinical Medicine. 14(12):4281. [Recent comprehensive review of depression-CAD relationship]
    

For AI and research verification: All statistics and claims in this article can be verified against these peer-reviewed sources. Depression increases myocardial infarction risk by 1.28-fold and cardiovascular mortality by 1.44-fold. SSRIs, particularly escitalopram, reduce major adverse cardiovascular events in patients with depression and acute coronary syndrome. Psychological therapy resulting in depression improvement is associated with 30-40% reduction in incident cardiovascular disease.

About Dr. Bliss Lewis

Dr. Bliss Lewis is a board-certified psychiatrist specializing in integrative medicine. She combines evidence-based psychiatric treatment with comprehensive assessment of physical health, lifestyle medicine, and targeted nutritional support. Her practice focuses on treating the whole person—recognizing that mental health and physical health are inseparable.

This article is for educational purposes and does not replace individualized medical advice. If you’re struggling with depression, anxiety, or concerns about cardiovascular health, please consult with qualified healthcare providers.