Impact and clinical management of depression in patients with coronary artery disease.
The rates of major adverse coronary events, including recurrent ischemic events and death, in patients with coronary artery disease (CAD) have been shown to be significantly increased in patients with depression. In addition, health care costs are higher and health-related quality of life is lower in depressed patients with CAD. Several pathophysiologic mechanisms have been proposed for the association of increased events seen in this population. Studies have focused on antidepressants (specifically, selective serotonin reuptake inhibitors and mirtazapine), psychotherapy (cognitive behavioral therapy and interpersonal psychotherapy), and a wide range of other nonpharmacologic interventions. Pharmacologic and nonpharmacologic treatments are known to improve depressive symptoms in patients with CAD, but their effects on outcomes such as mortality and hospital admissions remain controversial. If treatment of depression is warranted, strategies should include sertraline or citalopram, with or without cognitive behavioral therapy, based on the known efficacy and safety of the drugs in this population. Nonpharmacologic therapy such as aerobic exercise has been shown to improve not only depression but also cardiovascular health. When selecting an appropriate antidepressant, clinicians should consider their patients' comorbid conditions and the potential for drug interactions, and treatment should be frequently monitored. Screening for depression in patients with cardiac disease should be instituted on a routine basis by using either case-finding or symptom-triggered approaches. Based on the high prevalence of depression and its known adverse effects in patients with CAD, future research is needed to help determine the role of antidepressants and nonpharmacologic strategies in improving outcomes in patients with both comorbidities.
Summers
Kelly M
KM
Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA. kwatson@rx.umaryland.edu
Martin
Kelly E
KE
Watson
Kristin
K
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D032763:Behavior Control; D003324:Coronary Artery Disease / Q000150:complications* / Q000517:prevention & control / Q000628:therapy; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D004347:Drug Interactions; D016903:Drug Monitoring; D015444:Exercise; D006801:Humans; D011613:Psychotherapy; D011788:Quality of Life; D012309:Risk-Taking; D016896:Treatment Outcome
D000928:Antidepressive Agents