Identifying and Treating Depression in Patients With Heart Failure

Abstract

Depression is a common comorbid condition in patients with heart failure (HF) that often goes undiagnosed and untreated. Unless symptoms of depression are specifically looked for, they can be easily missed or mistaken for HF. Clinical depression is a syndromal diagnosis based on patient history, the report of signs and symptoms, and the exclusion of competing diagnoses. This article describes the recommended strategies for recognizing and diagnosing depression. General, psychotherapeutic, and pharmacological approaches to treatment of depression in HF are also discussed. General treatment measures include optimization of medical therapy, patient education, exercise, social support, and family care. Although there are many types of psychotherapy, cognitive-behavioral therapy is particularly appropriate for patients with HF and is described in this article. Categories of antidepressant drugs, including serotonin reuptake inhibitors, tricyclic antidepressants, and miscellaneous antidepressants, are reviewed relative to treating depression in patients with HF. Given the high prevalence and adverse impact of untreated depression in patients with HF, it is essential for advanced practice nurses to develop the requisite knowledge and skills for the identification and treatment of depression.

Marital Status as an Independent Predictor of Event-Free Survival of Patients With Heart Failure

“…Interventions to improve depressive symptoms in CHD including pharmacotherapy and non-pharmacological interventions (i.e., cognitive behavioral therapy) have evidence of improvement of depressive symptoms 31. The ENRICHD trial is the only study designed to decrease depressive symptoms and improve social support using cognitive behavioral therapy 32.…”

Effects of Depression on Sexual Activity and Sexual Satisfaction in Heart Failure

“…20 Antidepressants tend to be prescribed by psychiatric and primary care providers rather than by cardiologists 21 or cardiac advanced practice nurses. 22 Selective serotonin reuptake inhibitors, however, have been associated with increased incidence of sexual adverse effects including ED and decreased libido, 23,24 and nearly half of psychiatric patients taking antidepressant medications report sexual dysfunction. 6 Also contributing to ED are several drugs commonly prescribed in treating HF.…”

The Effect of Educational Intervention on Nurses’ Attitudes and Beliefs about Depression in Heart Failure Patients

“…The numerous symptoms associated with heart failure impair physical function, often causing social limitations, feelings of powerlessness, and inability to fulfill work and family roles. The resulting psychosocial stress can lead to frustration, disillusionment, and depression [2]. Three primary components influence the etiology of depression in heart failure patients: (1) symptomatology (e.g., fatigue, sleep problems); (2) behavioral characteristics (e.g., reduced physical activity); and (3) shared biological processes (e.g., neurohormonal inflammation and dysregulation).…”