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Screening, referral and treatment for depression in patients with coronary heart disease.

Abstract

In 2003, the National Heart Foundation of Australia position statement on "stress" and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD. The prevalence of depression is high in patients with CHD and it has a significant impact on the patient's quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting. To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2-3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening. Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved. Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided. Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.

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  • Authors+Show Affiliations

    ,

    University of Queensland, Brisbane, QLD, Australia.

    , , , , , , , , ,

    Source

    The Medical journal of Australia 198:9 2013 May 20 pg 483-4

    MeSH

    Australia
    Comorbidity
    Coronary Disease
    Depression
    Humans
    Mass Screening
    Referral and Consultation
    Risk Factors

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    23682890

    Citation

    Colquhoun, David M., et al. "Screening, Referral and Treatment for Depression in Patients With Coronary Heart Disease." The Medical Journal of Australia, vol. 198, no. 9, 2013, pp. 483-4.
    Colquhoun DM, Bunker SJ, Clarke DM, et al. Screening, referral and treatment for depression in patients with coronary heart disease. Med J Aust. 2013;198(9):483-4.
    Colquhoun, D. M., Bunker, S. J., Clarke, D. M., Glozier, N., Hare, D. L., Hickie, I. B., ... Branagan, M. G. (2013). Screening, referral and treatment for depression in patients with coronary heart disease. The Medical Journal of Australia, 198(9), pp. 483-4.
    Colquhoun DM, et al. Screening, Referral and Treatment for Depression in Patients With Coronary Heart Disease. Med J Aust. 2013 May 20;198(9):483-4. PubMed PMID: 23682890.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Screening, referral and treatment for depression in patients with coronary heart disease. AU - Colquhoun,David M, AU - Bunker,Stephen J, AU - Clarke,David M, AU - Glozier,Nick, AU - Hare,David L, AU - Hickie,Ian B, AU - Tatoulis,James, AU - Thompson,David R, AU - Tofler,Geoffrey H, AU - Wilson,Alison, AU - Branagan,Maree G, PY - 2013/5/21/entrez PY - 2013/5/21/pubmed PY - 2013/7/31/medline SP - 483 EP - 4 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 198 IS - 9 N2 - In 2003, the National Heart Foundation of Australia position statement on "stress" and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD. The prevalence of depression is high in patients with CHD and it has a significant impact on the patient's quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting. To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2-3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening. Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved. Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided. Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes. SN - 1326-5377 UR - https://www.unboundmedicine.com/medline/citation/23682890/full_citation L2 - https://www.mja.com.au/doi/10.5694/mja13.10153 DB - PRIME DP - Unbound Medicine ER -