Depression commonplace in people with heart disease

The American Heart Association has issued new guidelines recommending that all patients with heart disease should be routinely screened for depression.

Numerous studies have shown that depression is more prevalent in people with coronary heart disease than it is in the general population. For example, depression is three times more common among people who have recently had a heart attack – 15-20% of heart attack patients meet diagnostic criteria for major depression, and even more patients have an elevated level of depressive symptoms. Furthermore, research has shown that depression increases the risk of further/recurrent cardiovascular morbidity, whilst also increasing the risk of cardiovascular mortality.  

These findings have led to the issue of the new guidelines:

• All patients with coronary heart disease should be screened for depression. 
• Patients with positive screening results should be evaluated by a professional qualified in the diagnosis and management of depression.
• Treatment should be tailored to the individual patient. Treatment options include: antidepressant drugs, cognitive behavioral therapy, and physical activity/exercise.
• Sertraline and citalopram are the first-line antidepressant drugs for patients with coronary heart disease.
• Patients with cardiac disease who are under treatment for depression should be carefully monitored for adherence to their medical care, drug efficacy, and safety, with respect to both their cardiovascular and mental health

Lichtman JH, Bigger JT, Blumenthal JA, Frasure-Smith N, Kaufman PG,Lespérance F, Mark DB, Sheps DS, Taylor CD, Froelicher ES.Depression and Coronary Heart Disease. Recommendations for Screening, Referral, and Treatment. A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. Published online before print September 29, 2008, doi: 10.1161/CIRCULATIONAHA.108.190769.