Mental Health, Alzheimer's, Dementia

Heart Patients Should be Screened and Treated for Depression, Says Heart Association

No evidence that treating depression improves coronary heart disease outcomes, but plenty shows depression worsens outcomes

Sept. 30, 2008 - Heart patients should be screened for depression - a common condition that can profoundly affect both prognosis and quality of life - according to the American Heart Association's first scientific statement on depression and coronary heart disease. The statement was published in Circulation: Journal of the American Heart Association.

The recommendations, which are endorsed by the American Psychiatric Association, include:

  ● early and repeated screening for depression in heart patients;

  ● the use of two questions to screen patients -- if depression is suspected the remaining questions are asked (9 questions total);

  ● coordinated follow-up for both heart disease and depressive symptoms in patients who have both.

	News Update
	Death from Depression Growing Concern: Now Linked to More Deaths Among Older Diabetics Patients with both diabetes and depression had increased risk of about 36% to 38% of dying from any cause Oct. 1, 2008
	Related Stories
	Those Treating Diabetes More Likely Get Depressed Than Those Who Ignore It   Link to video in story   Research also suggests possibility of depression increasing risk of type 2 diabetes June 17, 2008 Rush Researcher Continues to Prove Depression is Alzheimer's Risk Factor Latest of multi-year studies says depression does not increase in early dementia By Tucker Sutherland, editor & publisher April 8, 2008 Depression Raises Risk of Death for Heart Attack Victims for Years After Attack Only about 25 to 30% of these patients receive antidepressant drugs, treatment March 3, 2008 Senior Citizen Men Get Depressed from Low Free Testosterone Level Testosterone supplement may contribute to successful treatment March 3, 2008 Depression is a Killer for Heart Attack Victims, Study Finds 'There is a whole series of factors that link depression and heart disease' Dec. 8, 2007 Large Study Proves Antidepressants Lower Suicide Risk for All Adults National Institute of Mental Health funds study of 226,866 patients July 6, 2007 Elderly Patients Not Responding to Depression Therapy Improve with Second Drug 84% of depressed elderly have problems in initial treatment June 1, 2007 Senior Citizens and Depression is Latest on NIHSeniorHealth National Institute on Aging, National Library of Medicine work together to produce special senior-friendly Website January 16, 2007 Parkinson Studies Find More Apathy than Depression, Experience Needed for Brain Stimulation Parkinson disease affects 1 of every 100 people over the age of 60 July 11, 2006 Violence by Dementia Patients in Nursing Home Associated with Key Factors Depression, delusions, hallucinations and constipation linked to aggression June 27, 2006 Depression in Senior Citizens Found to Diminish Ability to Plan and Control Late-Onset Depression emerges in people aged 60 and older June 23, 2006 Lifetime Depression Links to Alzheimer's Through Tangles in the Brain Increased plaque and tangles also lead to more rapid cognitive decline Feb. 6, 2006 Think You’re Depressed, Anxious? New Research Says Watch for Dementia April 14, 2005 Depression Most Often Confused with Alzheimer’s June 14, 2004 Distress-prone People more likely to Develop Alzheimer's Disease Dec. 12, 2003 Read the latest news on Alzheimer's, Dementia & Mental Health

"The statement was prompted by the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook," said Erika Froelicher, R.N., M.A., M.P.H., Ph.D., a professor at the University of California San Francisco, School of Nursing and Medicine and co-chair of the writing group.

Dale Briggs, who experienced depression after his heart valve surgery, said the statement is welcome news. "I think it's long overdue. It is unfortunate that some patients aren't warned of the possibility of some depression after surgery," he said.

Briggs is the volunteer executive vice president of Mended Hearts, Inc., a national non-profit organization affiliated with the heart association, offering resources and support for heart surgery patients. He shares his experience with new cardiac patients during hospital visits -- one of the main patient-to-patient support services offered by Mended Hearts.

Recommended Questions Patient Health Questionnaire: 2 Items* Over the past 2 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 the answer is “yes” to either question, then refer for more comprehensive clinical evaluation by a professional qualified in the diagnosis and management of depression or screen with PHQ-9. Patient Health Questionnaire-9 (PHQ-9)* Depression Screening Scales Over the past 2 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. (3) Trouble falling asleep, staying asleep, or sleeping too much. (4) Feeling tired or having little energy. (5) Poor appetite or overeating. (6) Feeling bad about yourself, feeling that you are a failure, or feeling that you have let yourself or your family down. (7) Trouble concentrating on things such as reading the newspaper or watching television. (8) 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. (9) Thinking that you would be better off dead or that you want to hurt yourself in some way. *Questions are scored: not at all_0; several days_1; more than half the days_2; and nearly every day_3. Add together the item scores to get a total score for depression severity.

"Since my surgery, I've visited about 1,000 patients. During a visit I always let patients know that this may happen, and encourage them to talk to their doctor about getting treatment," he said. "I've had a number of people call me through the years and thank me for warning them about the possibility of depression."

Experts say depressed cardiac patients have at least twice the risk of second events in the one to two years after a heart attack. Furthermore, studies have shown that more severe depression is associated with earlier and more severe second cardiac events, Froelicher said.

For example, one study found that 15 percent to 20 percent of hospitalized heart attack patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression. An even greater proportion showed more depressive symptoms than usual in the population, though not sufficient to meet these criteria.

The study also found that some subgroups of patients, such as young women with heart disease, seem particularly vulnerable to depression.

"Studies show that depression is about three times more common in patients following a heart attack than in the general community," said Judith H. Lichtman, Ph.D., M.P.H., writing co-chair of the statement and associate professor of epidemiology at Yale University School of Medicine in New Haven, Conn.

"Because there has been no routine screening for depression in heart patients, we think there is a large group of people who could benefit from appropriate treatment."

Although depression was mentioned in earlier American Heart Association scientific statements, this is the first to specifically target the condition. Lichtman said more research is needed to determine why depression is associated with poorer outcomes.

Recent studies indicate that depressed patients are less likely to take their medicines as directed, improve their diets, exercise and attend cardiac rehabilitation sessions, all of which could contribute to a worse outcome, Lichtman said.

It's also possible that biological changes associated with depression such as reduced heart rate variability and increases in blood factors that encourage clot formation could increase risk, the statement said.

Other recommendations in the statement include:

  ●  Patients who have depressive symptoms should be evaluated by a professional qualified in diagnosing and managing depression, and should be screened for other psychiatric disorders, such as anxiety.

  ●  Treatment options include cognitive behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs or combinations of those treatments.

  ●  Selective serotonin reuptake inhibitor (SSRI) treatment soon after a heart attack is considered safe, relatively inexpensive and may be effective for treating depression.

  ●  Routine screening for depression in coronary heart disease patients should be done in multiple settings, including the hospital, physician's office, clinic and cardiac rehabilitation center, to avoid missing the opportunity to effectively treat depression in cardiac patients and improve physical health outcomes.

  ●  Coordination of care between health providers is essential for patients with combined medical and psychiatric diagnoses.

"Depression and heart disease seem to be very much intertwined," Lichtman said. "You can't treat the heart in isolation from the patient's mental health.

"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. 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."

Editor's Note:

Click here to full statement by AHA. (pdf)

Co-authors include J. Thomas Bigger, Jr., M.D.; James A. Blumenthal, Ph.D., ABPP.; Nancy Frasure-Smith, Ph.D.; Peter G. Kaufmann, Ph.D.; Francois Lesperance, M.D.; Daniel B. Mark, M.D., M.P.H.; David S. Sheps, M.D., M.P.H.; and C. Barr Taylor, M.D. Individual author disclosures are included on the manuscript.

Mended Hearts is a community-based, nationwide heart patient support network founded in 1951. More than 17,000 members operate through 300 chapters and satellite organizations across the United States, with two chapters in Canada. Recognized for its role in facilitating a positive patient-care experience, Mended Hearts partners with 430 hospitals and rehabilitation clinics offering heart patient support through visiting programs, group meetings and educational forums.

For more information, visit http://www.mendedhearts.org/.

Information source: American Heart Association - Web Site: http://www.americanheart.org/

Keep up with the latest news for senior citizens, baby boomers