Bringing the heart-brain axis into pharmacy practice

Last month, I followed up with a patient to whom I had taught daily heart-focused breathing techniques to manage her anxiety. She told me, "I've noticed something strange. Not only am I feeling calmer, but I'm also sleeping better and making clearer decisions at work." By consciously altering her heart rhythm patterns through breathing, she was directly influencing her cognitive and emotional state.As pharmacists, we have likely been exposed to and read about our gut-brain axis. However, many of us have not incorporated the equally vital heart-brain connection into clinical practice and our lives. This emerging field can transform our approach to patient counselling, business decisions and personal wellness.Heart-brain and gut-brain systemsBoth the gut-brain axis and the heart-brain system rely on bidirectional communication via the vagus nerve, the longest nerve in the body, which travels from our brain stem to our diaphragm. The heart communicates with the brain through three distinct pathways:Neurological Network: The heart contains its own "mini-brain" with 40,000+ neurons. It sends signals to the brain via vagal nerves and the spinal cord, influencing emotional processing and decision-making.1Biochemical Signalling: The heart secretes crucial hormones: atrial natriuretic peptide, oxytocin, and brain natriuretic peptide. These messengers directly impact brain function and our emotional state.2Electromagnetic Communication: The heart generates the body's largest electromagnetic field, measured up to 3 feet outside the body, with an amplitude 60 times greater than brain signals.3Heart rate variabilityHeart Rate Variability (HRV) represents the variation in time between consecutive heartbeats, measured in milliseconds. It is commonly regarded as the best quantitative measure of resilience. Research demonstrates that higher HRV correlates with improved emotional regulation, cognitive flexibility, and stress resilience.4In clinical terms, HRV serves as a biomarker of our physiological coherence—the degree to which our heart, mind, and emotions operate in energetic alignment. When we achieve coherence through specific breathing techniques, we can measurably improve our HRV within minutes, leading to enhanced decision-making and emotional stability.From theory to practiceUnderstanding these interconnections has helped my clinical practice. Now, I understand how medications, including antidepressants, can affect heart rhythm patterns and emotional processing pathways. This allows me to validate patients' experiences while providing evidence-based explanations.This knowledge can also transform your pharmacy's operations. Research by the HeartMath Institute demonstrates that coherent breathing patterns, including 5-second inhales and 5-second exhales, can shift our autonomic nervous system into a parasympathetic state within 3-5 minutes.5 Implementing brief coherence breaks using heart-focused breathing techniques can help regulate your nervous system, improving presence and problem-solving. Studies show that coherent states improve cognitive flexibility, allowing access to more creative solutions during challenging situations.6Practical coherence technique for pharmacists:Place attention on your heart regionBreathe slowly and rhythmically (5 seconds in, 5 seconds out)Activate a positive feeling (appreciation, care, compassion)Maintain this state for 1-3 minutesYou can perform this simple technique between patient consultations, during inventory management, or before difficult conversations. When there is a will, there is a way, and although you may feel this is not possible, I assure you it can be incorporated into your daily routine.Counselling through the heart-brain lensMy awareness of the impact of antidepressant medications on the heart-brain connection has adjusted my counselling approach for patients using them.Important clinical contextBefore discussing heart-brain considerations, it's crucial to emphasize that antidepressants are evidence-based treatments for depression and anxiety disorders. For most patients, the benefits often significantly outweigh the potential side effects. However, understanding the broader physiological impact allows for more comprehensive patient care.When I dispense a new antidepressant prescription, I discuss both the primary therapeutic effects and the heart-brain considerations. Depending on the patient's level of comfort with starting and what their primary care prescriber told them, I may also share how some patients experience changes in emotional responsiveness, including what researchers term "emotional blunting"—a reduction in the intensity of both positive and negative emotions.[7]This approach has deepened patient interactions. Recently, a patient who had been on an antidepressant for three years mentioned feeling "better but different." Using my understanding of the heart-brain connection, we had a meaningful conversation about emotional blunting and whether this trade-off was still working for her.For some patients, especially those with severe depression or anxiety, some emotional dampening is a worthwhile trade-off. For others, it might become unacceptable long-term. This knowledge allows for more nuanced discussions about medication expectations and potential adjustments.I also discuss complementary approaches like breathwork, mindfulness practices and building community connections. These support patients in eventually discontinuing medication when stable and, if needed, open a conversation about the best way to come off the meds.In my career, I have seen countless patients who started an SSRI during difficult times and remained on it indefinitely because no healthcare provider initiated a conversation about stopping. As the most accessible healthcare provider, we play a crucial role in collaborating with primary care providers to establish STOP dates and facilitate proper discontinuation planning.Personal well-being in pharmacy practiceA 2023 study of healthcare workers found that those practicing coherent breathing techniques showed a 23% improvement in job satisfaction and a 31% reduction in burnout symptoms over 8 weeks.8 These techniques offer scientifically validated stress management tools for pharmacists facing increasing workplace pressures.Integrating this knowledge hasn't just changed how I practice, it has changed how I experience pharmacy. The constant pressure used to leave me emotionally drained. Understanding my heart-brain connection has given me practical tools to maintain well-being.I now practice brief coherence techniques between patient consultations. Before challenging conversations, I take 15 seconds to regulate my heart rhythm patterns. This simple practice preserves my energy throughout the day and makes me a more effective pharmacist.“Compassion and commerce are neurologically compatible.”This knowledge has been a foundational pillar for restoring meaning to my work. It has helped me see the patients I serve more holistically. By connecting with patients on both scientific and emotional levels through explaining the physiological background for their experience while acknowledging their emotions, I have rediscovered why I chose this profession.Manjit Hansra is a CDE and consultant pharmacist focused on providing tools to help pharmacists prevent and manage burnout. Subscribe to my newsletter HERE.Sources:Armour, J. A. (2003). Neurocardiology: Anatomical and functional principles. Heart Rhythm, 1(3), 292-295.Gutkowska, J., & Jankowski, M. (2012). Oxytocin revisited: its role in cardiovascular regulation. Journal of Neuroendocrinology, 24(4), 599-608.McCraty, R., & Shaffer, F. (2015). Heart rate variability: new perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Global Advances in Health and Medicine, 4(1), 46-61.Thayer, J.F., & Lane, R.D. (2009). Claude Bernard and the heart–brain connection: further elaboration of a model of neurovisceral integration. Neuroscience & Biobehavioral Reviews, 33(2), 81-88.HeartMath Institute. (2016). Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health Risk. Research Report.Bradley, R.T., et al. (2010). Emotion self-regulation, psychophysiological coherence, and test anxiety: results from an experiment using electrophysiological measures. Applied Psychophysiology and Biofeedback, 35(4), 251-288.Price, J., et al. (2009). Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study. British Journal of Psychiatry, 195(3), 211-217.Ginsberg, J.P., et al. (2023). Heart rate variability training for healthcare worker stress management: a randomized controlled trial. Journal of Occupational Health Psychology, 28(2), 134-147.