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Depression in heart patients prompts call for screening

Having a heart attack can make you sad.

That may seem obvious, but heart patients are more likely to experience serious depression, and it's often overlooked, heart experts said Monday.

In a sweeping recommendation, the American Heart Association said doctors should screen all heart patients for depression, and refer them for further treatment if needed. The measure was endorsed by the American Psychiatric Association as well.

"Unfortunately, sometimes there's such an emphasis on getting the patient on the wide variety of (heart) medications available," said Dr. Paul Phillips, cardiology chief at Morton Plant Hospital in Clearwater. "Sometimes the psychiatric aspect of the disease gets missed."

Here's a look at the recommendation:

Why do doctors need to ask about depression?

After a heart attack, patients are three times more likely to be depressed than the general population. About 15 percent to 20 percent of heart attack patients meet the standard for major clinical depression, one study said. Other heart patients, including those who get bypass surgery and those with congestive heart failure, also are more likely to be depressed.

Why do they feel that way?

Lutz resident Jennifer Curran said the sadness she felt after her heart attack a year ago was almost like a grieving process.

"What I was grieving was the loss of perfect health," Curran said.

Curran, 58, had no risk factors for heart disease. She was thin and healthy, exercised and didn't have a family history of heart problems. She was a happily married grandmother running her own business. Life was good — until her heart attack.

"The crying would just come on spontaneously," Curran said. "My heart had failed me. My body had failed me. I had to make all these changes. The fact that my body was broken and would never be the same, I couldn't wrap myself around that."

But her doctors, even though she thinks they provided excellent medical care, never asked if she was depressed.

Why is the heart association so concerned about depression?

Among patients who have had a heart attack, those who are depressed are at least twice as likely to have another cardiac event in the next two years. This may be partly because depressed patients may have more severe disease.

But depression also is linked to failure to take heart medicines, participate in cardiac rehabilitation programs and make other changes.

"If you're very depressed and you can barely get up in the morning, there's little reason to worry about your risk factors and ways to make yourself live longer," said Erika Froelicher, co-chair of the group that wrote the recommendations and a nursing and epidemiology professor at the University of California at San Francisco.

What are doctors supposed to do?

Ask each patient two questions about whether they are experiencing sadness and lack of interest in life. Patients who seem depressed will be asked seven more questions. Cardiologists might then treat the patients or refer them to a mental health provider.

How will patients be treated?

Patients can be treated with antidepressants, therapy, exercise and cardiac rehabilitation.

Are the drugs dangerous for heart patients?

Zoloft and Celexa are the best drugs for heart patients, the group says. Certain drugs, such as tricyclics and MAOIs, should be avoided.

How will the recommendation affect heart patients?

Phillips hopes the recommendation will help heart patients realize there's nothing wrong with feeling depressed.

"The label of a psychiatric diagnosis is something the patient sometimes can't accept," he said. "It's hard enough to accept the label that you've had a heart attack or a bypass. … If you know it's part of a normal reaction, I think patients will be much more accepting about getting treatment."

For Curran, realizing she wasn't alone helped ease her sadness. She enrolled in a cardiac rehab program and began attending support group meetings.

"I met 14 other women with heart problems," she said. "I realized I needed to start giving thanks for living through the heart attack. … It helped me put it in a little better perspective."

Lisa Greene can be reached at greene@sptimes.com or (813) 226-3322.

Depression in heart patients prompts call for screening 09/29/08 [Last modified: Tuesday, September 30, 2008 2:40pm]
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