Heart Patients Prone to Depression

Amid a dismal economy, rising food and health-care costs, and an uncertain job market, even the most optimistic person can get "down and out." But factor in a serious medical condition, and the result could be—depression. Scientists recently confirmed the long-held notion that diabetes contributes to depression, and vice versa, and multiple studies have shown a strong link between heart disease and depression. As a matter of fact, depression is so common among cardiac patients that the American Heart Association (AHA) recently issued new guidelines recommending that all heart patients be routinely screened for signs of depression.

“Studies show that depression is about three times more common in patients following a heart attack than in the general community,” said Judith Lichtman of Yale University School of Medicine, who helped write the new guidelines. Moreover, depressed heart patients are more likely to neglect their prescribed medications and are less likely to stay on a healthy diet and exercise regime, making them more vulnerable to recurrent heart problems. “There is no direct evidence yet that treating depression improves coronary heart disease outcomes, but plenty of evidence shows that having depression worsens those outcomes,” she said. “By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it.”

The recommendations call for all heart patients to be screened by initially asking two standard questions: Over the past two weeks, have you had little interest or pleasure in doing things? Have you felt down, depressed, or hopeless? If the patient answers yes to one or both, they should be further evaluated with seven additional questions:

1. Trouble falling asleep, staying asleep, or sleeping too much
2. Feeling tired or having little energy
3. Poor appetite or overeating
4. Feeling bad about yourself, that you are a failure, or that you have let yourself or your family down
5. Trouble concentrating on things such as reading the newspaper or watching television
6. Moving or speaking so slowly that other people could have noticed or being so fidgety or restless that you have been moving around a lot more than usual
7. Thinking that you would be better off dead or that you want to hurt yourself in some way

Screening could take place in a variety of medical settings; at the hospital, doctors’ office, clinic or cardiac rehabilitation centers. If depression is indicated, the patient may be referred to a professional qualified in treating the condition. Treatment strategies for patients with coronary disease and depression include antidepressant drugs, behavioral therapy, and exercise or a combination. The antidepressants Zoloft, sold as the generic sertraline, and Celexa, sold as generic citalopram, are considered good first-line therapies, as research has shown they are generally safe for cardiac patients.

These guidelines could potentially affect millions of Americans, including 16 million who have heart disease and 8.1 million who have suffered a heart attack. Erika Froelicher, RN, MPH, PHD, professor of nursing and epidemiology and statistics at the University of California, San Francisco and co-chair of the group that created the recommendations, said the hope is that routine screening for depression will be done on every cardiac patient. “I believe a lot of depressed cardiac patients are overlooked,” she said. “Unless you screen formally, you can miss a lot of people.”

The American Psychiatric Association endorsed the new recommendations, which were published online in advance of the October 21 issue of Circulation: Journal of the American Heart Association.