“Therefore, it is important to assess depression in cardiac patients with the goal of targeting those most in need of treatment and support services,” the committee concluded.
The advisory also includes an overview of treatment options for depression, including antidepressant drugs, cognitive behavioral therapy, lifestyle modifications, and combinations of these options.
Data suggest that treatment with SSRIs soon after acute MI is safe and effective. First-line treatments are sertraline and citalopram; among contraindicated treatments are tricyclic antidepressants and monamine oxidase inhibitors, which have cardiotoxic side effects, the advisory states.
Cognitive behavioral therapy can also be of benefit, and may be an alternative for those who cannot or will not tolerate pharmacologic therapy. In some patients, a combination of pharmacologic and psychotherapy works best. Depending on cardiac status and exercise capacity, patients might also benefit from aerobic exercise and cardiac rehabilitation alone or in combination with other treatments, but individual assessment is necessary for determining the appropriate approach.
In a written statement from the AHA, Dr. Lichtman stressed that “you can't treat the heart in isolation from the patient's mental health.”