March 10, 2011

Working Together on Hearts and Depression

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Reviewed by: 
Joseph V. Madia, MD By:

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Collaborative care helps heart disease patients with depression

(dailyRx News) Depression can negatively affect the course of the disease and quality of life in patients with heart disease. However, researchers have identified one method that may improve the emotional health of heart patients.

Help for depressed heart patients may lie in collaborative efforts, according to a new study by Jeff C. Huffman, M.D., assistant professor of psychiatry at Harvard Medical School, and colleagues. More specifically, the study found that hospital-initiated, low-intensity collaborative care programs can substantially improve depression, anxiety, and emotional quality of life in patients with heart disease (also known as cardiovascular disease).

dailyRx Insight: Using collaborative care after a heart problem can decrease depression.

Collaborative care programs for managing depression bring together the patient, the primary medical physician, and a psychiatrist in order to tackle the mental health problem. Such programs include written and verbal information about depression and its effect on heart disease; scheduling enjoyable leisure time after being discharged from the hospital; receiving detailed treatment options; and arranging follow-up care after discharge. The collaborative process is coordinated by a non-physician care manager.

In a study that involved 175 depressed heart patients, Huffman and colleagues compared the mental health outcomes of 'usual care' to the outcomes of collaborative care.

Although collaborative care programs for managing depression have been used in outpatient settings, this study looked at how such programs would work in the hospital.

Six weeks after being discharged from the hospital, collaborative care patients were more likely to experience a reduction in their depressive symptoms compared to patients who received usual care (59.7 percent versus 33.7 percent). Patient outcomes were similar 12 weeks after discharge: 51.5 percent of collaborative care patients - compared to 34.4 percent of usual care patients - reported their depressive symptoms were cut in half or more.

Even though both groups had similar re-hospitalization rates, patients who received collaborative care reported substantially fewer and less severe symptoms of heart disease. Furthermore, six months after discharge, collaborative care patients were more likely than usual care patients to stick to a healthy diet and exercise.

This is only the beginning for hospital-initiated collaborative care, according to Huffman. It is good to know that the program examined in this study improved mental health. However, Huffman adds, a program might need to be more intense if we want to see improved medical outcomes. In addition, more research is needed to see how the program would affect a more diverse population.

Depression impacts an estimated 15 million adults in the United States. Depression is a state of prolonged low mood and aversion to activity. A person's thoughts, behavior, feelings and physical well-being are affected and may include feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, irritability, or restlessness. The primary treatments for major depression are psychological counseling and medications. Medication therapies include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs). SSRIs include: fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®) and escitalopram (Lexapro®). SNRIs include: duloxetine (Cymbalta®), venlafaxine (Effexor®) and desvenlafaxine (Pristiq®). Bupropion (Wellbutrin) is an NDRI. Atypical antidepressants include trazodone (Desyrel®) and mirtazapine (Remeron®). Each medication category has different side effects.

The study is published in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
March 9, 2011

Last Updated:
March 10, 2011