Depression and heart disease

Current Situation

  • In the UK, depression is the third most common reason patients consult with a GP.
  • Depression is often associated with medical comorbidity.
  • Over 45 per cent of patients who are admitted to hospital after an MI have depression.
  • Depressed patients with heart disease have worse medical outcomes, including increased risk of reinfarction and all-cause mortality.
  • Symptoms of depression are also present in an estimated one third of patients with heart failure.
  • The prevalence of depression is high in younger women who have acute MI (Arch Intern Med 2006; 24: 876-83).

What is the evidence?

  • One study has shown that depression is a clinically significant risk factor for developing CHD. This is especially true in both men and women who are aged between 25 and 50 (Am J Prev Med 2005; 29: 428-33).
  • Patients who are depressed in the weeks following an acute coronary syndrome have a poorer cardiac outcome (Am Heart J 2005; 150: 54-78).
  • Patients suffering from depression have been shown to have smaller gains in physical functioning following coronary bypass surgery (Circulation 2005; 111: 250-3).
  • SSRIs have proved to be effective in the treatment of depressive symptoms in cardiac patients and are also safe from the cardiovascular point of view (BMJ 2004; 328: 939-43).
  • Although antidepressant treatments are effective in treating depression in medically ill patients, their impact on medical outcomes has yet to be quantified (Curr Opin Psychiatry 2006; 19: 421-7).
  • A recent study found no added benefit of psychotherapy for patients with coronary artery disease and depression (JAMA 2007; 297: 367-79). Based on these results and those of previous trials, citalopram or sertraline plus clinical management should be considered as a first-step treatment for these patients.

Implications for practice

  • Depression is linked with a poorer quality of life and less successful rehabilitation.
  • Depressed patients are less likely than other patients to comply with their medication and they are likely to be sedentary.
  • Tricyclic antidepressants might be cardiotoxic and should be avoided.
  • Depression after an MI is associated with adverse outcomes, and younger women who are a high-risk group, may benefit from aggressive screening of post-acute MI depression.

Useful websites

  • www.bhf.org.uk/factfiles - British Heart Foundation.

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners' PasTest 2006

Key points

  • Depression is very common in patients with heart disease.
  • SSRIs seem to be effective.
  • Young women are at a high risk of depression.

 

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