RECENT RESEARCH IN Heart-Brain Medicine

Karina W. Davidson, PhD
David J. Kupfer, MD
J. Thomas Bigger, MD
Robert M. Califf, MD
Robert M. Carney, PhD
James C. Coyne, PhD
Susan M. Czajkowski, PhD
Ellen Frank, PHD
Nancy Frasure-Smith, PhD
Kenneth E. Freedland, PhD
Erika S. Froelicher, RN, PhD
Alexander H. Glassman, MD
Wayne J. Katon, MD
Peter G. Kaufmann, PhD
Ronald C. Kessler, PhD
Helena C. Kraemer, PhD
K. Ranga R. Krishnan, MD
Franc¸ Ois Lespe´rance, MD
Nina Rieckmann, PhD,
David S. Sheps, MD, MSPH
Jerry M. Suls, PhD

Click here to open Full Article PDF (Assessment and Treatment of Depression in Patients With Cardiovascular Disease: National Heart, Lung, and Blood Institute Working Group Report)

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ABSTRACT

The National Heart, Lung, and Blood Institute convened an interdisciplinary working group of experts to develop recommendations for the assessment and treatment of depression in patients with coronary heart disease (CHD).

METHOD

Consensus of experts.

RESULTS

Our current recommendations are that the Beck Depression Inventory-I be employed for epidemiological studies of depression and CHD, that the Patient Health Questionnaire 2-item version be employed for screening for trial eligibility, that the Depression Interview and Structured Hamilton (DISH) be employed for diagnostic ascertainment for trial inclusion, and that the Hamilton rating scale, which is part of the DISH, be employed for both depression symptom reduction and the remission criterion in any trial. We further recommend that a randomized controlled trial be undertaken to determine whether selective serotonin reuptake inhibitors, psychotherapy, or combined treatment can reduce the risk of CHD events and mortality associated with depression in CHD patients.

CONCLUSIONS

This report summarizes the recommendations made by the working group and discusses the rationale for each recommendation, the strengths and weaknesses of alternative approaches to assessment and treatment, and the implications for future research in this area.

CITATIONS

1. Krishnan KRR, Delong M, Kraemer H, Carney RM, Spiegel D, Gordon C, McDonald W, Dew MA, Alexopoulos G, Buckwalter K, Cohen PD, Evans D, Kaufmann PG, Olin J, Otey E, Wainscott C.
   Comorbidity of depression with other medical illnesses in the elderly. Biol Psychiatry 2002;52:559–88.
   http://www.ncbi.nlm.nih.gov/pubmed/12361669
2. Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, Czajkowski SM, DeBusk R, Hosking J, Jaffe A, Kaufmann PG, Mitchell P, Norman J, Powell LH, Raczynski JM, Schneiderman N.
   Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289: 3106–16.
   http://www.ncbi.nlm.nih.gov/pubmed/12813116
3. Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT Jr, Krishnan KR, van Zyl LT, Swenson JR, Finkel MS, Landau C, Shapiro PA, Pepine CJ, Mardekian J, Harrison WM, Barton D, McLvor M;
   Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002;288:701–9.
   http://www.ncbi.nlm.nih.gov/pubmed/12169073
4. Serebruany VL, Suckow RF, Cooper TB, O’Connor CM, Malinin AI, Krishnan KR, van Zyl LT, Lekht V, Glassman AH;
   Sertraline Antidepressant Heart Attack Randomized Trial. Relationship between release of platelet/endothelial biomarkers and plasma levels of sertraline and Ndesmethylsertraline in acute coronary syndrome patients receiving SSRI treatment for depression. Am J Psychiatry 2005;162:1165–70.
   http://www.ncbi.nlm.nih.gov/pubmed/15932816
5. Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, van Zyl LT, Finkel MS, Krishnan KR, Gaffney M, Harrison W, Califf RM, O’Connor CM;
   Sertraline AntiDepressant Heart Attack Randomized Trial Study Group. Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Circulation 2003;108: 939–44.
   http://www.ncbi.nlm.nih.gov/pubmed/12912814
6. Carney RM, Blumenthal JA, Freedland KE, Youngblood M, Veith RC, Burg MM, Cornell C, Saab PG, Kaufmann PG, Czajkowski SM, Jaffe AS.
   Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study. Psychosom Med 2004;66:466 –74.
   http://www.ncbi.nlm.nih.gov/pubmed/15272090
7. Taylor CB, Youngblood ME, Catellier D, Veith RC, Carney RM, Burg MM, Kaufmann P, Shuster J, Mellman T, Blumenthal JA, Krishnan R, Jaffe AS, for the ENRICHD Investigators.
   Effects of antidepressant medication on morbidity and mortality in depressed post-MI patients. Arch Gen Psychiatry 2005;62:792– 8.
   http://www.ncbi.nlm.nih.gov/pubmed/15997021
8. Appendix: Summary of Instruments. National Heart, Blood, and Lung Institute Working Group, Assessment and Treatment of Depression in Patients with Cardiovascular Disease. NHBLI Web site. Available at: http://www.nhlbi.nih.gov/meetings/workshops/depression/instruments.htm
   Accessed June 10, 2005.
9. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J.
   An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.
   http://www.ncbi.nlm.nih.gov/pubmed/13688369
10. Beck AT, Steer RA, Brown GK.
    Manual for Beck Depression Inventory II (BDI-II). San Antonio, TX: Psychology Corporation; 1996.
11. Rush AJ, Giles DE, Schlesser MA, Fulton CL, Weissenburger J, Burns C.
    The Inventory for Depressive Symptomatology (IDS): preliminary findings. Psychiatry Res 1986;18:65– 87.
    http://www.ncbi.nlm.nih.gov/pubmed/3737788
12. Freedland KE, Skala JA, Carney RM, Raczynski JM, Taylor CB, Mendes de Leon CF, Ironson G, Youngblood ME, Krishnan KR, Veith RC.
    The Depression Interview and Structured Hamilton (DISH): rationale, development, characteristics, and clinical validity. Psychosom Med 2002;64: 897–905.
    http://www.ncbi.nlm.nih.gov/pubmed/12461195
13. Kessler RC, Ustun TB.
    The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93–121.
    http://www.ncbi.nlm.nih.gov/pubmed/15297906
14. Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Wang P, Wells KB, Zaslavsky AM.
    Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 2005;352:2515–23.
    http://www.ncbi.nlm.nih.gov/pubmed/15958807
15. Kessler RC, Berglund P, Borges G, Nock M, Wang PS.
    Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA 2005;293:2487–95.
    http://www.ncbi.nlm.nih.gov/pubmed/15914749
16. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS.
    Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8 –19.
    http://www.ncbi.nlm.nih.gov/pubmed/8279933
17. Strik JJ, Honig A, Lousberg R, Denollet J.
    Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. Psychosomatics 2001;42:423– 8.
    http://www.ncbi.nlm.nih.gov/pubmed/11739910
18. Rush AJ, Trivedi MH, Carmody TJ, Ibrahim HM, Markowitz JC, Keitner GI, Kornstein SG, Arnow B, Klein DN, Manber R, Dunner DL, Gelenberg AJ, Kocsis JH, Nemeroff CB, Fawcett J, Thase ME, Russell JM, Jody DN, Borian FE, Keller MB.
    Self-reported depressive symptom measures: sensitivity to detecting change in a randomized, controlled trial of chronically depressed, nonpsychotic outpatients. Neuropsychopharmacology 2005;30: 405–16.
    http://www.ncbi.nlm.nih.gov/pubmed/15578008
19. Murray CJL, Lopez AD. Quantifying the burden of disease and injury attributable to 10 major risk factors. In: Murray CJL, Lopez AD, eds.
    The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Cambridge MA: Harvard University Press; 1996.
20. Schatzberg AF, Rush AJ, Arnow BA, Banks PL, Blalock JA, Borian FE, Howland R, Klein DN, Kocsis JH, Kornstein SG, Manber R, Markowitz JC, Miller I, Ninan PT, Rothbaum BO, Thase ME, Trivedi MH, Keller MB.
    Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not. Arch Gen Psychiatry 2005; 62:513–20.
    http://www.ncbi.nlm.nih.gov/pubmed/15867104
21. Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, Norquist G, Howland RH, Lebowitz B, McGrath PJ, Shores-Wilson K, Biggs MM, Balasubramani GK, Fava M.
    Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006;163:28–40.
    http://www.ncbi.nlm.nih.gov/pubmed/16390886
22. Unutzer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noel PH, Lin EH, Arean PA, Hegel PT, Tang L, Belin TR, Oishi S, Langston C.
    Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002;288:2836–45.
    http://www.ncbi.nlm.nih.gov/pubmed/12472325
23. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G.
    Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145–53.
    http://www.ncbi.nlm.nih.gov/pubmed/10639539
24. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML.
    Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877– 83.
    http://www.ncbi.nlm.nih.gov/pubmed/11907286
25. Katon WJ, Von Korff M, Lin EH, Simon G, Ludman E, Russo J, Ciechanowski P, Walker E, Bush T.
    The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry 2004;61:1042–9
    http://www.ncbi.nlm.nih.gov/pubmed/15466678