Stress, Anxiety and Depression



How do stress, anxiety and depression related to cardiovascullar disease?

Stress has a terrible reputation, but it’s not always bad for you. In fact, it’s essential for survival. Being nervous before an important meeting or having sweaty palms at the top of the ski hill are the kinds of normal human responses created in response to stress, and they can help to motivate and heighten awareness. But exposure to too much stress for too long has a very damaging effect on your heart and overall health.

In 2011, nearly one-quarter of Canadians reported that most days were “extremely or quite a bit stressful.” The percentage of women reporting stressful days was slightly higher than that of men. This kind of long-term exposure to stress takes a toll on your cardiovascular system and leaves you vulnerable to anxiety, depression and CVD.

Learning to manage stressful situations can help you reduce this risk or avoid making your condition worse if you are already living with cardiovascular disease.


Stress is your mind and body’s response to a perceived threat or or stressor, triggering the instinct known as the fight-or-flight response.5 It can occur when either good or bad things happen in your physical environment, your personal relationships, your work or when you experience a major life change.

When faced with a stressful situation, your body reacts by circulating stress hormones (adrenaline and cortisol). These hormones send signals that prepare your body to take action, called a stress response. As a result, your heart rate and blood pressure increase, your breathing becomes faster and shallow, you start to sweat, and your entire body tenses up.

When you are under stress, specific changes occur in your body, most of which you would never notice:

  • Fat cells released into the bloodstream for extra energy become converted into cholesterol.
  • Platelets, the body’s blood clotters, become more “sticky” and start building up inside your arteries.
  • Your blood pressure increases for extended periods of time.
  • Your overall patterns of daily life begin to change in ways that make it more difficult to eat well, exercise regularly, and get enough rest.
  • All these negative effects increase your risk for cardiovascular disease. The stress response is overactive in both anxiety and depression.


Anxiety is more than the occasional or daily stress. It is one of the most distressing emotions people experience. The most common anxiety is “general anxiety,” and it can often lead to an anxiety disorder. It includes periods of nervousness or fears that often happen during difficult moments in life. Anxiety becomes a serious problem when it is persistent and interferes with your daily life, affecting your behaviour, thoughts, feelings and physical sensations.

Usually, anxiety develops when a combination of risk factors occurs and triggers an emotional overload of sorts. Sometimes anxiety is overshadowed by another mental disorder, such as depression or bipolar disorder (in which episodes of depression and mania are present). When this is the case, it’s hard to tell what the underlying cause of anxiety might be.

Anxiety increases the risk for palpitations, an irregular heartbeat, and heart that races or spasms. Any 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.


Almost everyone feels sad or depressed at times, but clinical depression is stronger and lasts longer. When sadness is accompanied by the inability to cope with everyday life, it may indicate depression. When depressive symptoms are severe over an extended period of time, every aspect of a person’s life can be affected, including physical health, relationships, and work.

There is no single cause of depression, but a combination of factors or situations can increase the risk. Typical contributing causes to depression include unfortunate life events, illness, a chemical imbalance in the brain, genetics, certain medications and drug or alcohol abuse.

With depression, you can have elevated levels of stress hormones. These have direct physical effects that put your heart at risk. They increase the risk of blood clotting and cause problems with the inner lining of your blood vessels. This leads to the buildup of plaque and to the development of atherosclerosis, or hardening of the arteries.

Depression also has indirect effects that cause added risks to your heart. It weakens your immune system and, like anxiety, influences some of the decisions you make around exercise, healthy eating, smoking, and taking medications safely.

People with depression have a more difficult time finding the energy and drive to make healthy lifestyle changes.

What are the other effects of stress on your body?

When you live a stressful life, it can be very difficult to make healthy lifestyle choices. Exposure to high stress levels may cause you to skip exercise or eat unhealthy foods. You may even respond by overeating, smoking, and consuming too much alcohol.

A number of additional health risks may be associated with stress. The most common include autoimmune diseases, gastrointestinal problems, high blood pressure, immune system suppression and infertility.

Who is at risk for stress?

Any sort of change can make you feel stressed out, but different groups of people react differently and are more sensitive to stress:


  • Women are more likely than men to report physical and emotional symptoms of stress.
  • Many women play significant roles both in the home and in the workforce, making them more susceptible to stress than men.
  • Women who feel the strain of working in high-pressure jobs have, overall, a 40 per cent higher risk of heart disease. Research has found a stronger link between depression and anxiety disorders and heart disease in women than in men.
  • How much we earn and how well we live also are closely linked to overall health. Women are more likely to have lower socio-economic status than men, and women with lower socio-economic backgrounds and lower levels of education also have higher rates of heart disease than educated women in higher income brackets.


  • Teenagers have higher expectations to succeed, the stress of school, numerous extracurricular activities, peer pressure, and job responsibilities.

Older adults:

  • They make up the core working group, with more responsibilities.
  • Older adults are most likely to be managing multiple careers and supporting a family, dealing with a reduced income related to retirement, or caring for elderly parents.

People with chronic illnesses:

  • This group has a tendency to focus on illness and the issues surrounding it.
What are the risk factors for anxiety and depression?


There is no single cause for anxiety. Generally, anxiety stems from a combination of factors. Anxiety disorders usually result from more complex causes. The risk for anxiety depends on multiple factors, including genetic predisposition, past experience, beliefs and behaviour, gender (women are more commonly diagnosed or hospitalized with anxiety compared with men) and environment or life events.


Depression can affect anyone at any time and tends to affect women more than men. Although it can occur at any age, it generally begins in the late teens to mid-20s. The risk for depression increases in heart disease patients. About one in five heart patients experiences clinical depression. Other risk factors include a family history of depression, stressful life situations (such as problems with relationships or stress at work, home, or school), negative life events (for example, childhood abuse or divorce) and imbalances in neurotransmitters (chemicals that transmit messages between brain cells)


Symptoms of stress can affect different aspects of your life and can be divided into four categories.







  • Difficulty concentrating or thinking
  • Memory problems
  • Negativity or lack of self-confidence
  • Constant worry
  • Difficulty making decisions
  • Moodiness
  • Low morale
  • Irritability
  • Hopelessness or helplessness
  • Apprehensiveness
  • Anxiety or nervousness
  • Sadness or a sense of guilty
  • Agitation or an inability to relax
  • Difficulty concentrating or thinking
  • Memory problems
  • Negativity or lack of self-confidence
  • Constant worry
  • Difficulty making decisions
  • Changes in eating or sleeping patterns
  • Social withdrawal
  • Nervous habits (nail-biting, foot tapping)
  • Increased use of caffeine, cigarettes, alcohol, or other drugs
  • Neglecting family or work responsibilities
  • Decline in performance or productivity

Symptoms of Anxiety and Drepression include:




  • Uncontrollable worry
  • Restlessness
  • Irritability
  • Muscle tension
  • Light-headedness
  • Sleeping problems
  • Fatigue
  • Breathing difficulty
  • Increased heart rate
  • Sweating


  • Sadness
  • Loss of interest in previously enjoyable activities
  • Changes in appetite associated with weight change
  • Sleeping problems
  • Loss of energy
  • Difficulties with concentration or memory
  • Decrease in normal social activities or withdrawal from friends and family
  • Feelings of worthlessness, helplessness, or hopelessness
  • Reduced interest in sexual activity
  • Thoughts of death or suicide
How is Stress Diagnosed?


Stress does not require a diagnosis because it is not a mental illness. Rather, prolonged stress poses a danger to your mental health that can eventually lead to illness. Because stress is such an individual experience, it’s important you identify what your own personal life stressors are so that you might better address and treat them.


For general anxiety, diagnosis begins with you. Try to identify whether you have experienced any of the following on most days for six months or more:

  • Frequent worrying
  • Intense focus on certain life situations (work or finances)
  • Distress or burden from constant worry

If have experienced any of these, it’s important you seek advice from your doctor or a qualified psychologist or psychiatrist who can provide appropriate options for treatment.

This online tool at Here to Help can evaluate your risk for depression and anxiety. Please note that it is intended as an educational aid and is not designed to provide a clinical diagnosis.

General anxiety can be treated with coping strategies and cognitive therapy, which promote positive thinking and help change anxious thoughts into more positive emotions. More severe anxiety disorders may require medication therapy using antidepressants or anti-anxiety medications.


Diagnosing depression usually begins with talking to your doctor about any symptoms you are experiencing. Because your doctor may have no idea you’re depressed, it’s important you tell him or her what you’re feeling.

Effective treatment options include cognitive therapy, medication, and supportive counselling. A combination of these may achieve the best results for reducing your feelings of depression.

Find a therapist near you at Psychology Today.

If your feelings of depression are particularly intense or have lasted a long time, you may benefit from consultation with a doctor. If your depression includes physical symptoms, such as sleeping difficulties, loss of appetite, or fatigue, then it is important to speak with a doctor. Antidepressants are sometimes prescribed under these circumstances. This video offers tips on managing stress, anxiety, and depression (University of Ottawa Heart Institute).

How Can I Lower My Stress?

When you reduce your stress, you not only help yourself, you help others around you. Stress can make you irritable and more prone to anger. When stress becomes severe, you risk taking out your frustrations on family members and friends.

Keeping your stress under control can reduce the chances that it will affect your loved ones. At the same time, your risk for anxiety and depression will diminish, as will the likelihood of damage to your heart health. When you reduce your stress, your friends and loved ones are more likely to enjoy your company and help you maintain a sense of well-being.

Learn ways to manage and control stress through coping strategies, such as:

  • Identifying what causes you stress
  • Finding ways to reduce the amount of stress
  • Creating a healthy plan to relieve stress and its harmful effects3

Although you can’t live a life that is entirely stress-free, you can do your best to avoid stressful situations. For example:

  • Learn to say no
  • Avoid overscheduling
  • Prepare (as best you can) for the events or moments you know will be stressful
  • Set realistic goals

Finally, manage your stress with these basic guidelines in mind:

  • Be physically active every day. This will help reduce the effects of stress.
  • Identify and maintain your strong support networks and good family relationships.
  • Get more information on stress management.
  • Ask for help if stress becomes a concern.

Coping with Stress from the Heart and Stroke Foundation, includes skills and practical techniques for reducing stress, as well as information on finding help and different options for treatment.