Healing an injured or poorly functioning heart requires attention to a patient's mental well-being as well as to his or her physical health -- so much so that in October, the American Heart Assn. recommended that doctors screen all heart patients for depression with a short questionnaire.
The American Psychiatric Assn. also endorsed this advisory, but some researchers think the blanket recommendation goes too far.
Dozens of studies have found depression occurring alongside heart disease. Whereas 4% to 10% of the general population reportedly suffers from depression, that number shoots to 15% to 40% in heart disease patients. But a survey found that about half of cardiologists don't address their patients' mental states.
"Depression is diagnosable, easily treatable and can make such a difference in the long-term outcome," says Dr. Carolyn Robinowitz, a psychiatrist in Washington, D.C. If doctors heed the new advisory, she says, "I think we will save a lot of lives."
Others say the science is incomplete. Studies have shown that depression can worsen heart disease, and treating depression improves, at least to some degree, a patient's mental well-being. But no research to date has proved that treating depression improves the patient's cardiovascular prognosis or life span.
Last week, a panel of experts in cardiovascular health and depression, writing in the Journal of the American Medical Assn., concluded there isn't enough evidence to support screening every heart patient for depression. As many as one-third of patients would say yes to some of the screener questions, says lead author Brett Thombs, a psychologist at McGill University in Montreal. Identifying so many people as potentially depressed could cause many to seek help (and medications) they don't need.
"It's hard to understand how this would be beneficial for patients," Thombs says. "We would advocate that clinicians be more aware of depression. . . . We're just not advocating that everyone be handed a questionnaire."
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Effects of surgery
Erika Froelicher, a professor of nursing at UC San Francisco and co-author of the American Heart Assn. advisory, says the benefits of screening outweigh the risks. She says that even if depression treatment doesn't directly affect heart disease outcome, it could improve quality of life for many patients.
