Depression and anxiety

In persons with heart failure, depression and anxiety are common conditions. As many as one in five persons with heart failure have mild to moderate symptoms of depression and a smaller group have more severe depressive symptoms. Depression is most common in those with more severe heart failure symptoms and physical limitations. The overlap of symptoms of depression and symptoms of heart failure often makes the diagnosis of depression more difficult, which may sometimes delay recognition of the diagnosis. Depression can cause several important symptoms such as low self-esteem, feelings of hopelessness, powerlessness, concentration difficulties, anxiety, irritation, fatigue, and physical ailments.

Having depression may make it more challenging to follow recommended medical treatment and perform self-care. Anxiety and depression may also decrease quality of life, and lead to fatigue and a deterioration of functional status. Currently, there is no specific medication or psychotherapy that is found effective for patients with heart failure. Most anti-depressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), appear to be safe in persons with heart failure. However, cognitive-behavioural therapy, which is a psycho-social intervention that aims to improve mental health and assist in the development of personal coping strategies, has been shown to improve outcomes in patients with heart failure.

Being diagnosed with heart failure often means substantial changes are required within daily living and activities. Adapting to those changes can be challenging and sometimes leads to emotions such as anxiety, stress, and depression. Below are examples of some different situations that can cause emotional reactions when you have heart failure:

  • Feeling worried that something serious will suddenly happen
  • To have a feeling of not having control over how the heart disease will develop
  • Feeling stressed and having difficulty relaxing
  • Feeling sad about having a heart condition and being limited in your physical ability

All these emotions are natural, and you are not alone in feeling them. Some patients feel resistance and anger at having these more difficult feelings and this can make them experience the feelings even stronger. Accepting the emotions instead of trying to suppress them can be difficult but this is a necessary first step in helping you to manage emotions.


Anxiety is an often-overlooked condition in persons with heart failure. Anxiety is a form of fear, which has the task of making you aware of dangers and preparing us to seek protection. This is called the “fight or flight” reaction. It is not controlled by your own will. In situations where the fear has a clear cause, for example fear of heights, it is easy to avoid what causes the fear. When there is nothing easily identifiable that can be eliminated or avoided, such as having a diagnosis of chronic heart failure, coping becomes more difficult.

Common symptoms of anxiety are having difficulty breathing, feeling dizzy, nausea, upset stomach, a lump in the stomach or a weight over the chest. You may feel your heart beating faster than usual as well as sweating, a feeling of cold inside, dryness in the mouth, a need to urinate or a feeling of tingling or numbness in your hands or feet.

You may notice that some of the signs of depression and anxiety, such as fatigue and shortness of breath, are very similar to the symptoms of heart failure. One way to differentiate between symptoms of depression, anxiety and heart failure is to pay attention to whether the symptoms occur in connection with exertion. Symptoms of heart failure generally worsen with physical exertion and decrease at rest, while symptoms of depression and anxiety can occur regardless of whether you move or not and may actually improve after physical exertion. It is important that you discuss your symptoms of mental distress with your treating physician or heart failure nurse.

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ESC Guidelines for Heart Failure

What patients need to know

This guide for patients from the European Society of Cardiology aims to provide an overview of the latest evidence-based recommendations for the diagnosis and treatment of heart failure.

In particular, it should help patients to understand the:

  • main types of heart failure
  • medicines used to treat heart failure
  • devices that may be appropriate
  • importance of rehabilitation
  • management by a multidisciplinary team
  • importance of self-care in managing your own condition

Learn more


A series of 9 simple, captivating animations explaining heart failure and its treatment.

These narrated animations explain how a healthy heart works, what happens to it in heart failure and how various treatments work to improve your health.


In this section you can watch, listen or read interviews with other people with heart failure and their caregivers.


and share your own views and experiences with other patients, families and caregivers. is a European Society of Cardiology website

The website was developed under the direction of the Heart Failure Association of the European Society of Cardiology (ESC). The ESC is a world leader in the discovery and dissemination of best practices in cardiovascular medicine. Our members and decision-makers are healthcare professionals who volunteer their time and expertise to represent professionals in the field of cardiology in Europe and beyond.

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