Check All Heart Patients for Depression?

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.