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Depression Screening Urged for Heart Patients

American Heart Association Science Advisory cites high prevalence of depression, recommends strategies for clinicians

TUESDAY, Sept. 30 (HealthDay News) -- Because coronary heart disease is often accompanied by depression, clinicians should aggressively screen patients for symptoms of depression and provide appropriate treatment, according to an American Heart Association Science Advisory published online Sept. 29 in Circulation: Journal of the American Heart Association.

Judith H. Lichtman, Ph.D., of Yale University School of Medicine in New Haven, Conn., co-chair of the Prevention Committee of the American Heart Association Cardiovascular Nursing Council, Clinical Cardiology Council, Epidemiology and Prevention Council, and Interdisciplinary Council on Quality of Care and Outcome Research, and colleagues cite a recent study showing that the 12-month prevalence of major depression is significantly higher among heart patients than in those with no comorbid medical illness (9.3 percent versus 4.8 percent), and that outcomes are significantly worse in heart patients with depression.

Among their recommendations: routine screenings of heart patients in hospitals, physicians' offices and cardiac rehabilitation centers; referral of patients with positive screening results to appropriate mental-health professionals; careful monitoring of patients receiving antidepressant treatment for signs of worsening depression and suicidality; and coordination of care between health care providers.

"Treatment options include antidepressant drugs, cognitive behavioral therapy, and physical activity, such as aerobic exercise and cardiac rehabilitation," the authors write. "Although antidepressant use has been associated with both increased and decreased cardiac risk in some epidemiological studies, randomized clinical trials have demonstrated that two selective serotonin reuptake inhibitor antidepressants, sertraline and citalopram, are safe for patients with coronary heart disease and effective for moderate, severe or recurrent depression."

Several members of the writing group disclosed prior financial support from pharmaceutical companies.

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