We’ve all probably said it at one time or another: “If my job (or my home life or my financial situation) gets any more stressful, I’m going to have a heart attack.” Mostly we’re kidding…but the truth is that mental stress can hurt our hearts.

In fact, there’s a name for this condition. With mental stress-induced myocardial ischemia (MSIMI), mental stress triggers a reduction in the flow of blood and oxygen to the heart muscle. People with MSIMI—which includes nearly 45% of patients with coronary heart disease—may experience chest pain when they’re feeling anxious or stressed out, but they also may have no noticeable symptoms. Either way, MSIMI can cause damage to the heart, interfering with normal motions of the heart wall and/or reducing the amount of blood the organ is able to pump…and increasing the risk for heart attack and death.

The good news: A recent study from Duke University showed that taking a selective serotonin reuptake inhibitor (SSRI) antidepressant for six weeks significantly reduced the likelihood of MSIMI episodes. Cardiologist Suzanne Steinbaum, DO, author of Dr. Suzanne Steinbaum’s Heart Book, called the study “extremely promising” because it is the first to show that a stress-reducing medication can help treat MSIMI.

The not-so-good news: SSRI drugs can have unwanted side effects—including nausea, insomnia, dizziness, weight gain, headache, low libido, erectile dysfunction and even thoughts of suicide. So if you have heart disease (or if you want to lower your risk for it), it’s wise to try other stress-reducing strategies first, Dr. Steinbaum said.

DR. STEINBAUM’S PILL-FREE FIXES FOR MENTAL STRESS

There are many powerful ways to reduce stress and therefore help your heart. They’re not as “high-tech” as a drug—but they are safe and proven and most are a whole lot less expensive! If you haven’t yet incorporated the following into your normal routine, now’s the time to do so, Dr. Steinbaum said…

Practice deep breathing. When you’re anxious or stressed, you automatically begin breathing more shallowly. This triggers the body’s physiologic stress response, increasing heart rate and blood pressure and upsetting the proper acid/base balance in the body, making you feel even more anxious. So whenever you start to feel stressed and breathless, try this—inhale through your nose to a slow count of four…hold for four…exhale through your mouth with a shhh sound for a count of six…hold for another four…then repeat several times.

Make time to connect with friends. “We can manage our stress by talking, by reaching out to other people, by building a network of supportive people who ‘tend and befriend’ us,” Dr. Steinbaum said. If you’ve been “too busy” for friends, rethink your priorities for your heart’s sake.

Participate in activities that boost levels of the feel-good hormone serotonin. Exercise, yoga, meditation, massage and laughter all increase serotonin. Getting enough sleep and enough sunlight also are important for maintaining levels of this hormone. Another strategy Dr. Steinbaum recommended is to increase your consumption of foods high in tryptophan, an amino acid the body uses to make serotonin. Good food sources of tryptophan include chicken, turkey, whole wheat, oat bran, tahini, quinoa, nuts and dark chocolate.

Consider seeing a therapist. The right professional counselor could completely change your life by helping you uncover any negative self-talk or overblown fears that compound your stress…and guiding you to develop an attitude of optimism, acceptance and balance. Ask your friends or your doctor for referrals. “If you try someone and don’t like that person, don’t give up on therapy—shop around until you find the right person,” said Dr. Steinbaum.

THE STRESS-BUSTING STUDY

If you have been diagnosed with coronary heart disease, it’s a good idea to talk to your doctor about any anxiety, stress or depression you may be experiencing—because any of those conditions could cause MSIMI as well. Though you many never have heard of MSIMI, many coronary heart disease patients do have it (particularly women, unmarried men and those who live alone, the Duke research suggests). Then, if the strategies above are not enough to relieve your mental stress, it’s time to discuss the new study with your doctor to see whether adding an SSRI to your stress-reduction regimen might be appropriate for you. Here’s what you’ll want to know about the study to initiate that conversation…

Patients who were known to have coronary heart disease were evaluated to see whether they also had MSIMI. To that end, the participants took three mental stress tests—solving a tricky math problem…tracing a diagram while watching their hand movements in a mirror…and telling a story about a time when they felt angry or sad—as well as a typical physical exercise stress test using a treadmill. EKG (a recording of the heart’s electrical activity), echocardiogram (a moving picture of the heart), blood pressure and heart rate measurements were used to assess heart function and determine whether each patient had MSIMI.

Next, 127 patients whose tests had revealed MSIMI were randomly assigned to receive either a placebo or the SSRI escitalopram (generic Lexapro) for six weeks. At the end of the six weeks, the mental stress tests and heart function tests were repeated.

Encouraging findings: Compared with placebo users, the SSRI users were 2.6 times less likely to experience MSIMI episodes during the mentally stressful tasks.

Questions do remain. For instance, because this study lasted only six weeks, we don’t know whether six weeks on SSRIs was enough to achieve maximum benefits or whether the participants’ MSIMI would have continued to improve with a longer course of treatment. We also don’t know whether or how soon MSIMI episodes would return once people went off the antidepressants…or whether SSRIs other than escitalopram would have similar benefits for MSIMI patients.

For now, though, Dr. Steinbaum said that what we have learned from the study is encouraging enough for heart disease patients who suffer from stress, anxiety or depression or who have been diagnosed with MSIMI to speak with their doctors about giving SSRIs a try to see whether they help and whether the side effects are tolerable. Remember, though, even if SSRIs do help you, it makes sense to also continue with the nondrug stress reducers described above—because with those, you have nothing to lose…and your heart has much to gain.