Circulation: The American Heart Association issued an advisory regarding the need for screening, referral, and treatment of depression in people with coronary heart disease (CHD). Depression is more prevalent in CHD patients and can contribute to a number of negative outcomes for the disease. Major depression that is comorbid with CHD is associated with more ambulatory and emergency care visits, days spent in bed because of illness, and functional disability; it is also associated with worse coronary prognoses. Additionally, depression is associated with decreased adherence to medications, medical treatment regimens, successful modifications of other cardiac risk factors, and participation in cardiac rehabilitation. Regardless of whether “depression affects cardiac outcomes directly or indirectly, the need to screen and treat depression is imperative.”
The advisory included the use of the Patient Health Questionnaire as part of the assessment of depression and depressive symptoms. Once depression is diagnosed, the three recommendations for treatment are antidepressant drugs, physical activity, and cognitive behavioral therapy (CBT), alone and/or in combination. At least 12 to 16 sessions of cognitive behavioral therapy over 12 weeks were advocated to achieve remission of moderate to severe depression.
Advisory authors: J. H. Lichtman, J. T. Bigger, J. A. Blumenthal, N. Frasure-Smith, et al.