Survivors often leave the hospital with invisible wounds. Experts say screening, counseling, and coordinated follow‑up should be standard parts of recovery.
A state‑of‑the‑art review in JACC: Advances argues that survivors of sudden cardiac arrest (SCA) and people who experience shocks from an implantable cardioverter‑defibrillator (ICD) face a high—but frequently overlooked—risk of anxiety, depression, and post‑traumatic stress symptoms that can derail recovery and day‑to‑day life. The authors call for mental health care to be built into cardiac pathways from hospital discharge onward.
How common—and how serious—is the problem?
Mental health symptoms after SCA are not rare. Pooled data show depression affects about 1 in 5 survivors soon after the event, rising to nearly 1 in 3 within a year. In one long‑term study, survivors with depression or anxiety had higher 14‑year mortality (36% vs 27%) than those without, underscoring the stakes of missed or untreated distress. The review also describes hallmark features after ICD shocks—hyper‑vigilance to body sensations, avoidance of activity, and catastrophic thinking—that shrink quality of life and social participation if unaddressed. (See the anxiety graphic on page 4.)
Why are needs missed?
Care has shifted toward remote device monitoring, which is convenient but reduces face‑to‑face chances to talk through fears. Web‑based psychological supports have been tried, but results are mixed, the review notes. Many patients also avoid exercise for fear of triggering fast heart rhythms or another shock—exactly the opposite of what helps cardiac recovery. Cardiac rehabilitation can improve self‑reported general health, yet referrals are inconsistent and life/logistical barriers limit attendance; offering referrals before discharge improves uptake.
What helps?
- Cognitive Behavioral Therapy (CBT) remains the mainstay, and the authors suggest weaving CBT into cardiac rehab so patients receive both physical re‑conditioning and coping skills in one place. Still, psychological care referrals are uncommon—one cohort found only 12% of young SCA survivors were referred—so building automatic referral steps is key (see Figure 2 on page 7).
- Peer and family support can reduce isolation; younger survivors in particular benefit from safe spaces to share experiences and “make sense” of what happened. Spiritual care may buffer distress for some.
- Yoga and breathing practices may ease anxiety for some—though evidence does not show yoga outperforms CBT for post‑SCA mental distress.
What about medications?
Selective serotonin reuptake inhibitors (SSRIs), especially when paired with psychotherapy, can be effective and have relatively favorable cardiac profiles; careful prescribing is essential because some antidepressants (for example, tricyclics) and certain antiarrhythmics can interact or raise arrhythmia risk. The review details common drug–drug interactions clinicians should watch for during combined therapy.
A roadmap for change
The article lays out a practical, recovery‑oriented model that starts with mental‑health assessment before discharge, followed by coordinated outpatient follow‑up led by a cardiopsychology team alongside cardiology, rehab, and (when needed) genetics or device clinics. The “Central Illustration” (page 3) and Figure 2 (page 7) depict this step‑by‑step pathway, while Table 1 lists system‑level fixes—from interprofessional training to value‑based metrics that include psychological well‑being. The authors also point to the “Copenhagen Framework” as an example of an integrated hospital‑to‑home program that flags cognitive and psychological needs early and personalizes support.
What this means for patients and families
- Ask for screening: Before leaving the hospital, request a mental‑health check and a referral plan alongside your cardiac follow‑ups. (See the care pathway on page 7.)
- Join cardiac rehab: It supports both body and mood—ask to be referred during your inpatient stay to boost the chance you’ll get in.
- Know effective options: CBT and peer support have the strongest track records; complementary practices are optional add‑ons, not replacements.
- Review medicines: If you’re prescribed antidepressants, make sure your team checks for interactions with heart‑rhythm drugs.
Bottom line: Surviving SCA or an ICD shock is not just a cardiac event—it’s a psychological one. Making mental‑health care routine could improve recovery, quality of life, and, potentially, long‑term survival.
Source: Torbey, E., Mena-Hurtado, C., Jackson, J. L., Samaan, Z., Sears, S. F., Pedersen, S. S., Lala, A., Thachil, R., Steiner, J., Ilonze, O. J., Jones, D., Watson, K., Price, A., Knoepke, C., Cheung, J. W., Smolderen, K., & ACC Cardiopsychology Work Group (2025). Impact of Sudden Cardiac Arrest and Implantable Cardiac Defibrillator Shocks on Mental Health: Review and Management Guidance. JACC. Advances, 4(6 Pt 1), 101797. https://doi.org/10.1016/j.jacadv.2025.101797
Editor’s note: This article is for information only and is not a substitute for professional medical advice.