Cardiac Problems Can Lead to Depression

Depression is about three times more common in heart attack survivors and those hospitalized with heart problems than the general population, according to the recommendations published in the journal Circulation. The authors said only about half of heart doctors say they treat depression in their patients -- and not all those diagnosed with depression are treated.

"I think we could reduce considerable suffering and improve outcomes," by screening, said Erika Froelicher, professor of nursing at the University of California, San Francisco. "I know we can do more."

Cardiac issues have become a major concern for HIV-positive adults on antiretroviral therapy, as some of the medications have been linked with increased cholesterol and triglyceride levels, which boost risks for cardiovascular disease and heart attacks. HIV disease itself also has been linked with increased risk for depression.

While there's no direct evidence that heart patients who are screened for depression fare better, depression can result in poorer outcomes and a poorer quality of life, the panel said. Depressed patients may skip their medications, not change their diet or exercise, or not take part in rehabilitation programs, they said.

All health care providers, including cardiologists, nurses, and primary care doctors, can and should be involved in determining whether a patient is depressed, said Froelicher, who was cochair of the panel that wrote the recommendations.

The panel suggests that heart patients be screened by first asking two standard questions: In 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, a questionnaire is recommended to determine if the patient is depressed and, if so, the severity of the depression. If depression is indicated, the patient may need to see a professional qualified in treating depression, the panel said, adding that treatment options include antidepressants, seeing a psychotherapist, and exercise.

"Some physicians are qualified to treat it -- others may be more comfortable referring the problem to a qualified mental health professional," Froelicher said.

Psychiatrist Michelle Riba said the statement's emphasis on frequent screening is important.

"What you want to see in a particular patient is how they do over time," said Riba, past president of the American Psychiatric Association, which has endorsed the heart association's recommendations.

One doctor said screening isn't enough; patients need close monitoring to make sure they get help.

"A lot of patients with depression don't follow up on it," said Mary Whooley, a professor of medicine at the University of California, San Francisco, who was not on the panel.

Barbara Forman, 62, struggled with depression after her double bypass about five years ago. She said she spent most of her time at her Englewood, Ohio, home sitting in her chair, frequently crying for no reason. When she did get out, she was often winded, even from a walk up a sidewalk to deliver cupcakes to her grandchild's classroom.

"I'm thinking Is this the way it's going to be for the rest of my life? Since I've had a heart event, is my life over?" she said. "It also made me afraid to do things. I didn't know how a heart attack felt. I would think, Is this a heart attack?'

A couple of months after she got home she called Mended Hearts, a group affiliated with the heart association that provides support to cardiac patients, and talked to someone who let her know depression was common in heart patients.

Her family doctor sent her to a psychologist, and after some initial reluctance, she started taking an antidepressant. That, along with starting a walking routine and volunteering with Mended Hearts and the heart association, improved her outlook.

"You can't sit in your house and just vegetate," she said. "Over the last 18 months to two years -- it's really gotten better." (AP, with additional reporting by HIV Plus.)