Check All Heart Patients for Depression?
Heart Disease and Depression Are Common; New Recommendations Call for Universal Screening
By
Kathleen Doheny
WebMD Health News
Reviewed By
Elizabeth Klodas, MD, FACC
Sept. 29, 2008 -- Heart disease and depression are so common that all heart
patients should be routinely screened for depression and referred for
professional help if necessary, according to new recommendations issued by the
American Heart Association.
The recommendations were spurred by growing evidence suggesting that
depression is common among cardiac patients and that the condition can worsen
patients' outcomes, making them more vulnerable to continuing or recurrent
heart problems.
This is the Heart Association's first "call to action" addressing
cardiac patients and depression, says Erika Froelicher, RN, MPH, PHD, professor
of nursing and epidemiology and statistics at the University of California, San
Francisco and co-chair of the writing group that created the
recommendations.
"The call for action is for health care providers who deal with cardiac
patients," she tells WebMD, and that includes doctors, nurses, and many
other health care professionals.
The hope, she says, is that routine screening for depression will be done on
every cardiac patient. "I believe a lot of depressed cardiac patients are
overlooked," Froelicher says. "Unless you screen formally, you can miss
a lot of people."
The American Psychiatric Association has endorsed the new recommendations,
published in the Oct. 21 issue of Circulation: Journal of the American Heart
Association.
Heart Disease & Depression: The Problem
Depression is about three times more common in patients after an attack than
in the general population, and it can also occur with other types of heart
problems. Many studies have found that depression is linked to a worse outcome
in heart patients, who are more apt to have repeat heart attacks, for
instance.
Heart Disease & Depression: The Recommendations
Among the new AHA recommendations:
- Administer a two-item questionnaire, asking the patient: "Over the past
two weeks, how often have you been bothered by any of the following problems?
(1) Little interest or pleasure in doing things. (2) Feeling down, depressed,
or hopeless."
- If a patient answers in the affirmative to either question, screening with
a more comprehensive questionnaire is recommended. The second questionnaire
includes nine items, asking about feelings of hopelessness, changes in appetite
or sleep habits, problems concentrating, and any instances of suicidal
thoughts.
Patients who score high on the second questionnaire should be referred to a
professional qualified in the diagnosis and management of depression. Cardiac
care providers can also elect to refer patients to depression specialists if
they answer in the affirmative on the initial two-question assessment.
In the advisory, the experts lay out the treatment options but leave it to
health care providers to tailor the treatments to individual patients. Among
the options to treat depression are antidepressant drugs, behavior or talk
therapy, and physical activity recommendations.
If medications are required, the antidepressants Zoloft and Celexa are
considered good first choices, the authors say, as research has shown they are
generally safe for cardiac patients.
Heart Disease & Depression: A Patient's View
Dale Briggs, 62, of Fresno, Calif., had a heart valve replaced in 1994
because of a condition called mitral valve prolapse, a common heart valve
disorder.
"My physical recovery was uneventful," he tells WebMD. Yet he began
to experience anxiety and had trouble sleeping, among other problems. One day,
sitting in his doctor's office, he saw a poster listing the signs of
depression. There were 18 in all, he remembers.
"I had all of them except the one that said 'thoughts of suicide,'"
he says.
He shared that with the doctor -- and told him "I am scared to death
this valve is going to kill me." The physician put him on an
antidepressant. That helped, he says.
"Then I discovered Mended Hearts," Briggs says. The national
nonprofit organization, affiliated with the American Heart Association, offers
resources and support for heart patients. Briggs began volunteering, and
estimates he has talked to more than 1,000 cardiac patients in the hospital. He
now serves as volunteer executive vice president of the organization.
Heart Disease & Depression: A Psychiatrist's View
The new recommendations "are terrific," says Michelle Riba, MD,
associate chair of integrated medical and psychiatric services and associate
director of the Depression Center at the University of Michigan, Ann Arbor. She
helps direct a joint program between the depression center and the university's
cardiovascular center, with the goal of meeting a heart patient's physical and
psychological needs.
"This is definitely in line with what we have been trying to do at the
University of Michigan."
SOURCES: Erika Froelicher, PHD, MPH, RN, professor of nursing and epidemiology and
biostatistics, University of California, San Francisco; co-chair of the writing
group for the recommendations. Lichtman, J. Circulation: Journal of the American Heart Association,
Oct. 21, 2008, vol 118: pp 1-5. Dale Briggs, insurance consultant and heart valve patient, Fresno, Calif.;
volunteer executive vice president, Mended Hearts Inc. Michelle Riba, MD, associate chair of integrated medical and psychiatric
services, department of psychiatry, and associate director, University of
Michigan Depression Center, Ann Arbor. Thombs, B. Journal of General Internal Medicine; January 2006, vol
21: pp 30-38.
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