Experts recommend screening for depression in cardiac patients

Background

Time and time again, studies have shown that many patients become depressed after suffering from major cardiac events. This occurs even after successful surgery and interventions. The reasons for this depression are many and may differ depending on the age of the patients (see previous post).

With this knowledge in mind, the American Heart Association (AHA) issued a new science advisory endorsed by the American Psychiatric Association which recommends that primary health care physicians should routinely screen their cardiac patients for signs of clinical depression. This would include referring suspected cases to mental health specialists for assessment, monitoring, and therapy.

Depression in heart patients

According to Dr Viola Vaccarino

“Despite a long-standing popular belief that stress and emotions affect the cardiovascular system, it was not until the mid-1980s that the first studies linking depression to higher mortality after a myocardial infarction (MI) began to appear in the medical literature. Since then, scientific interest in the link between depression and heart disease has grown steadily over time, with an increasing number of research studies addressing depression as a prognostic factor in cardiac patients. There is now a sufficient consensus that depression is a risk factor for coronary heart disease (CHD), as well as an important prognostic factor in cardiac patients. It is also recognized that depression is a growing global problem. By 2030, depression is projected to be the second leading cause of disability worldwide (after HIV/AIDS) and the number one cause of disability in high-income countries.“

Screening methods

The recommended assessment for depression in cardiac patients is fast and easy. The patients only have to initially answer 2 questions. Longers questionnaires may be needed when further assessment is deemed necessary.

Experts believe that the recommended questionnaires

“are validated tools and an efficient, evidence-based way of finding possible cases and referring them on for further assessment and treatment.”

However, a big problem would be how the patients would accept the recommendations for screening and the diagnosis of depression. People with heart disease would not necessarily be happy (and they are already unhappy) when they hear they have another clinical problem to face.

Treatments

The AHA advisory recommends pharmacological treatment of depression. As first line of treatment, the selective serotonin reuptake inhibitors (SSRIs) sertraline and citalopram are recommended. Furthermore, AHA cautions that some antidepressant drugs may have some cardiotoxic effects that can worsen existing cardiovascular conditions.

For those who cannot tolerate antidepressant medications or prefer nonpharmacological treatments, cognitive behavior therapy is recommended. A combination of both psychotherapy and medications may also work for some patients. The important thing is to find the right therapeutic approach for patients.

Coming soon: resource post alternative ways of fighting depression