My auntie has been missing and one of the possible factors for her being gone may be memory loss. She told us she was going to go to the clinic and they had told us that her blood pressure was really high. She hasn’t come back since and we want to know if her situation connects with memory loss. any comments will do about what depression can lead to or the causes of memory loss for a mid 50 year old woman

depression

Anxiety, on the other hand, is a fear of the future, whether known or unknown. For example, awakening in the morning and feeling fear in the pit of your stomach and yet having no idea why. Or, it could be a feeling of fear prior to making a speech to a small group of family members at a dinner party. Either way, that is anxiety.

The Symptoms:

Depression manifests itself as a lack interest in life itself, pessimism and a belief that the future holds nothing of value. Note, in true depression, fear of the future is not present, but on some occasions a depressed person will become anxious and become afraid of the unknown future.

The body slows down and certain chemicals are released. Similar chemicals (endorphins) are released when a patient relaxes deeply, for example whilst under hypnosis. As a world-wide teacher of Hypnotherapy, I always stress in my hypnotherapy training that ‘depression is a contra-indication’ to the use of hypnosis.

Should you use hypnosis with a depressed patient, you may deepen the state of depression even further because of the increased release of endorphins.

Of course, using hypnosis with a client who is suffering from anxiety is to be applauded as an induced relaxed state removes the anxiety and allows a non-critical analysis of the reason for the illness.

The Treatment:

People suffering from anxiety should always be taught a relaxation technique to allow the body to get back to normal as anxiety cannot be felt when the mind and body are relaxed.

In both cases, it is absolutely essential that the reasons for depression or anxiety is understood. With depression the sufferer almost always knows what causes it. With anxiety, if it is considered a problem, the cause is often unknown.

However, with analysis, either through a non-relaxation method such as imagery techniques for depression, or through relaxation techniques for anxiety, the sufferer can be taught to handle the situation in a more beneficial way.

Here are two examples.

With depression, a knowledge of the stages a depressive will experience as the depression takes hold, helps a sufferer to understand what is happening to him or her. This can help to get through the time it takes for the depression to ‘blow itself out’ as in the vast majority of cases, ‘time heals’.

Of course, there are other forms of depression that do not pass in time. A ‘manic depressive’ will vouch for that and the only obvious recourse is to take prescribed drugs and enter in to a long term of therapy. But, if you are suffering from depression as you read this, please remember that these are exceptional cases as the majority of depressed people get well with the passing of time.

Prescribed drugs for either depression or anxiety, must only be taken on a temporary basis as a sufferer can become dependant on them.

The treatment for anxiety are twofold. If the cause is known, for example feeling afraid of flying, then techniques can be taught that will enable you to relax (remember what I said about being unable to feel anxiety when relaxed?) in the situation that causes you the anxiety.

If the cause is unknown, recourse to some form of psychological treatment may be necessary. This would inevitably be in the form of analysing the problem and then learning how to deal with the anxiety.

You Are Not Alone:

In both cases, sufferers are not alone as almost everyone will at some time in their lives suffer with either depression or anxiety, or even both.

The depth of the depression or degree of anxiety depends on individual circumstances and a sufferer’s personality.

Unfortunately, those of us who are sensitive and caring suffer the most but there is always help on hand.

The study is published online in the Oxford University Press’s journal Human Reproduction on behalf of the European Society of Human Reproduction and Embryology.
The study found that pregnant women with symptoms of depression have an increased risk of preterm delivery, and that the risk grows with the severity of the depressive symptoms.

These findings also provide preliminary evidence that social and reproductive risk factors, obesity, and stressful events may exacerbate the depression-preterm delivery link, according to the researchers.



Because the majority of the women in the study did not use anti-depressants, the study provides a clear look at the link between depression and preterm delivery.

The study — which is among the first to examine depression and pre-term delivery in a representative and diverse population in the United States — looked at 791 pregnant Kaiser Permanente members in San Francisco city and county from October 1996 through October 1998.

Researchers interviewed the women around their 10th week of pregnancy and found that 41 percent of the women reported significant or severe depressive symptoms. The women with less severe depressive symptoms had a 60 percent higher risk of preterm delivery — defined as delivery at less than 37 completed weeks of gestation — compared with women without significant depressive symptoms, and the women with severe depressive symptoms had more than twice the risk.

“Preterm delivery is the leading cause of infant mortality, and yet we don’t know what causes it. What we do know is that a healthy pregnancy requires a healthy placenta, and that placental function is influenced by hormones, which are in turn influenced by the brain,” said lead author Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente’s Division of Research in Oakland.

“This study adds to emerging evidence that depression during early pregnancy may interfere with the neuroendocrine pathways and subsequently placental function. The placenta and neuroendocrine functions play an important role in maintaining the health of a pregnancy and determining the onset of labor,” Li explained.

“Post-partum depression has been extensively studied and discussed by the public, but depression during pregnancy is significantly under-recognized and under-diagnosed. Clinicians should pay close attention to depression during pregnancy to catch it early,” Li said. “If prenatal depression is indeed as prevalent as reported in this and other studies and doubles the risk of preterm delivery, then bringing depression to the forefront of prenatal care could lead to a significant reduction of preterm deliveries.”

In addition to being the leading cause of infant mortality and morbidity, preterm delivery is also the leading medical expenditure for infants, with estimated annual cost of about $26 billion in the United States alone. Presently, other than a prior history of preterm delivery and some pregnancy complications, very little is known for its risk factors and origins.

“The key strengths of this study are that it ascertained the depressive symptoms early in pregnancy, long before the preterm delivery occurred, therefore avoiding recall bias. In addition, the study was not clouded by antidepressant use because only 1.5 percent of the study population was prescribed antidepressants and we could exclude them in the analyses,” Li said. “Considering the increased use of antidepressants among pregnant women, this study’s findings may provide a rare opportunity to evaluate the effect of depression on risk of preterm delivery without the entanglements of antidepressants.”

Limitations of the study include researchers measuring the women’s depressive symptoms only once during pregnancy, rather than throughout the pregnancy, and participation rate in the study was low.

Published at Health News Track

When choosing methylsulfonylmethane or MSM for your life, you are making a choice popular today with people looking for an alternative to harsh chemicals or medications for many disorders and illnesses. MSM tablets have been increasingly popular because it is an easy to take pill that is going to put the ease or your supplement use.

Finding information on MSM tablets these days is not too difficult. In fact, the internet has become a hotbed of information on methylsulfonylmethane curing everything under the sun

. However, long term studies have not been completed to understand the exact consequences, if any, of taking this supplement on a long term basis.

While it is not difficult to see that MSM tablets can be helpful for arthritis, skin, hair, nails, and scar tissue, there are also other types of condition that are made better with the reported use of methylsulfonylmethane in their diet.

Let’s explore some of those conditions and how MSM tablets come into play.

Irritable Bowel Syndrome or IBS is an often debilitating condition of the gastric tract. IBS sufferers often find they are sensitive to medication, additives, preservatives, sweets, and just about anything that can irritate the GI tract. MSM has actually been found to be great for those with sensitive GIs.

However, it is recommended you start your MSM tablets at a smaller than usual dosage of around 250mg per day to start building up to around 2gms per day. If you suffer from IBS, you know when you have had too much; listen to your body.

Diabetes is the body not using insulin efficiently or the body not making enough insulin at all. One thing that many people do not realize is that sulfur and insulin are closely related. Sulfur is also related to Biotin. Many people claim that MSM tablets, powders, crystals, and other forms of methylsulfonylmethane are beneficial in allowing the body to control its own blood sugar levels.

Of course, diabetes can be deadly, and while the long term effects could very well help reduce your need for insulin with as little as 2gms per day, you should never quit taking your diabetes medication without a healthcare provider’s okay.

Depression is another one of those debilitating conditions that can put life on hold. When adding methylsulfonylmethane to the diet, many people living with depression have found that their mood swings stabilize and the overall symptoms associated with depression are minimized.

Seasonal allergies are another of the conditions where symptoms are lessened with the addition of methylsulfonylmethane to the diet. MSM tablets make the cell walls more permeable which means it lets more good stuff in and allows those toxins to be flushed from the body. With the addition of methylsulfonylmethane, people find their allergy symptoms such as sneezing, burning eyes, and runny nose are greatly reduced if not removed all together.

When taking methylsulfonylmethane, it is important to remember that regardless of the amount you take, drink plenty of fresh water with each dosage! While water is essential in our lives, plenty of water is needed to allow those MSM tablets to work their magic.

Depression tests are given by health providers in order to assess the level of depression of the patient. Different Depression Tests vary not only in their set of questions but on their assessment procedures as well.

Depression tests are grouped as self-test questionnaires given by health providers. There are several self tests for determining a person’s level of depression.

Self-Tests

Zung Depression Scale “ This is a 10 minute screening test with 20 questions. This is for people who experienced symptoms in the past 2 weeks

. Scoring includes 50-69 common range for depression and 70+ for severe depression.

Center for Epidemiologic Studies Depression Scale (CES-D) “ This test has a total of 20 questions. It was developed by Lenore S. Radloff for the assessment of depression symptoms for the past week. This also tracks the progress, on a weekly basis, in a short form. Depression is present when there are a 16+ point gained. This is also equivalent to 10+ points in short form of.

Geriatric Depression Scale (GDS) “ This is for adults. It is screening test with 30 questions and a short form of 15 questions. Scores indicates; 10-19 = for Mild Depression, 20-30 = for Severe Depression. For the Short Form, 4-10 = Mild Depression, 10-14 = Severe Depression.

Some of the detailed self-assessment depression tests are:

1. The National Mental Health Association Depression Screening

2. Mayo Clinic Depression Assessment

3. The Wakefiled Self-Report Questionnaire on Depression

Free Depression Tests Online

Anxiety and Depression Screening Test “ These are screening questions for assessing anxiety disorders as a mental illness.

Goldberg Depression Questionnaire “ This is designed by Dr. Ivan Goldberg. It consists of 18 questions. It can be answered with the use of a scale that responds to their feelings. Scoring comparison are: 54+ for Severely Depressed, 36-53 for Moderate to Severe, 22-35 for Mild to Moderate, 18-21 for Borderline Depressed, 10-17 for Possible Mild Depression, 0-9 for Likely Not Depressed.

Wakefield Depression Questionnaire “ This is composed of 12 questionnaires which can assess signs of depression at the moment you are answering it. A score of 15+ points needs a care of a mental health professional.

Tests Given By Health Care/Mental Health Professionals

Beck Depression Inventory (BDI) “ This is commonly used by health providers. This has about 21 multiple test questions that can assess a patient for the past two weeks who needs further treatment. The higher the score, the more severe the depression is.

The Depression-Arkansas Scale (D-ARK) “ This brief instrument developed test is made by Dr. G. Richard Smith. It has 11 questions that can assess disorders for the past 4 weeks. It is categorized by: 0-8 minimal, 9-12 mild, 13-8 moderate and 9+ severe.

Edinburgh Postnatal Depression Scale (EPDS) “ This depression screening test has about 10 questions which can assess the last 7 days, for further evaluation. 9+ points indicates a suicidal tendency and 1+ point for further care assessment via health providers.

Hamilton Depression Rating Scale (HAM-D) “ This has a total of 21 questions that can assess severe symptoms. This is handed by health professionals for proper monitoring. Severe indicates a high score.

Cornell Dysthymia Rating Scale (CDRS) “ This test assesses dysthymia symptoms. It has about 20 test questions.

Depression Tests are designed to determine the risk of developing a depressive disorder. The test is a series of questions which concerns the daily habits and mood swings. This can help identify symptoms for more evaluation and can only be done by professionals.

Depression tests are now on the tip of our hands offers instant free results. Aside from this, it can be done with confidential screening nowadays. The National Mental Association even started its web based tests so as to lower the risk of people not seeking help.

Although the disorder is highly treatable, The American Psychiatric Association states that eighty to ninety percent can be treated effectively with the help of depression testing. Once the testing is done, the report and personalized interpretation will pass through medical professionals for proper treatment.

Depression Tests is an early warning signal of the disorder. The best way to help a person is to undergo different tests so as to manage the stage of depression before it becomes full-blown. The type of depression will depend on the treatment given to the patient.

Symptoms of depression include the following:

loss of activity interest

sad mood

changes in body weight and appetite

less sleep or oversleep

loss of energy

agitation

inappropriate guilt

concentration difficulty

suicide attempts

and a feeling of worthlessness

Other warning signals include low motivation, extended fatigue and chronic frustration.

Depression Tests are not intended as the official diagnosis or a medical treatment substitute. This only serves as the primary route for the recommendation of a patient, especially for future plans of diagnosis and treatments. Treatment would include:

Antidepressant medications

Psychotherapy

Or both

Aside from this, a referral to a good psychologist or psychiatrist would ease these depression problems. Thus, in order to effectively carry out these tests, doctors do a background check on the patient, particularly for past depressive episodes. Observing different situations is also part of the diagnosis. This is where the doctors can identify if the patient is suffering from emotional or physical depression.

Labels:depression, Depression Tests, Antidepressant medications, Depression Scale, Symptoms of depression, Depression Questionnaire, self tests determining person’s depression level

Anxiety is extreme stress, sometimes panic. It can cause symptoms such as shortness of breath along with feelings of doom. You can experience anxiety when your body reacts to signals it thinks are threats. Your heart rate goes up and you start to sweat.

Other causes of anxiety can be classified as phobias, such as fear of flying or fear of heights. Herbs can be an easy way to help ease anxiety naturally. If you are taking anti-depressant drugs, however, do not try to substitute herbal remedies . Talk to your doctor before taking herbal remedies.

When treating anxiety, start with the mildest remedy in the mildest dosage and go from there. Many of the herbs used to treat anxiety are safely compatible.

Oats

Oat seeds are calming and soothing and are helpful for those suffering from daily stress or who feels frayed. Tea is the common method of taking oats. Steep 1 to 2 tablespoons of seeds in a cup of hot water for ten minutes. You can drink a cup of tea every two hours as needed. Tincture is also available and you can take up to 3 teaspoons every two hours. Oats are also available as capsules.

Chamomile

Used often as tea, chamomile has a very soothing and calming effect on you. It helps relax the muscles and also helps ease a tense stomach. Drink one cup of tea every two hours or up to 3 teaspoons of tincture every two hours. Chamomile is readily available as tea at most supermarkets, but it’s a good idea to keep some on hand.

Linden

Linden gently relaxes and eases muscle tension, and is also used as a remedy for high blood pressure. Linden also makes a good all-around remedy for helping keep the cardiovascular system functioning well. It is most often used in tea, and you should drink one cup of tea every two hours as needed. Tincture is also available as well as capsules.

Vervain

Vervain is an herb that soothes and calms the nervous system as well as helps with depression. Often found as a tea, drink one cup of tea every two hours. It is also available as a tincture and in capsules.

Motherwort

This old-time remedy is useful for the cardiovascular system in general. It can help calm nerves and aids in soothing anxiety that can cause a rapid heart rate. Drink one cup of Motherwort tea every two hours. It is also available as a tincture and as capsules. Consult your doctor before taking Motherwort if you are currently taking any cardiac drugs.

Lavender

Lavender is relaxing and uplifting. It is fragrant and offers relief for anxiety and depression. Lavender essential oil is used diluted in bath water or can be inhaled. To use in a bath, add 10 to 12 drops to a full tub. You can also dilute it with oil to use as massage oil. It should not be taken internally.

St. John’s Wort

Commonly used to treat depression, St. John’s Wort is an overall health booster that helps the nervous system. As a tonic, take up to 3 teaspoons every two hours. It is also available in capsule form.

Skullcap

Used for anxiety and hormonal mood swings, skullcap is relaxing to the nervous system. It can be taken as a tea, a tincture or in capsule form. To make tea, steep one or two teaspoons of dried herbs in a cup of hot water for 10 minutes. Drink one cup of hot tea every two hours as needed.

Kava-Kava

This is an anti-anxiety herb that originated in the South Pacific islands. It works similarly to Valium, working with the part of the brain that controls the nervous system and emotions. It does not cause addiction nor does the body build up a tolerance to it. It also doesn’t impair thinking the way drugs may. In fact, in studies it was shown to improve brain function and memory. It is a good solution to treat anxiety on a short-term basis. The standard form is in capsules. Do not take with alcohol.

Valerian

Valerian is considered a strong anti-anxiety herb. Similar to Valium, it works with the central nervous system; however it does not cause dependence. It is also used to improve sleep as well as a muscle relaxant. It is taken in capsule form. Note “ a small percentage of users indicate an increase in anxiety when taking this herb. If that happens, discontinue use.

Passionflower

Passionflower is a strong herb used primarily for calming and treating insomnia. It can also be used to help calm daytime anxiety. It is most commonly used as a tea. To make the tea, steep one to two teaspoons of dried herbs in a cup of hot water for 10 minutes. Drink one cup every two hours.

Siberian Ginseng

This herb helps restore adrenal glands that are overstressed. It is a good choice for those who are chronically overstressed, and is taken as a tonic. It has a cumulative effect, meaning that it may take several weeks or even months to see results from taking the tonic.

Labels:depression, drink, anxiety, capsules, remedy, drugs, nervous, teaspoons, herbs, tonic, lavender, motherwort, linden, soothing, steep, chamomile, nervous system, dried herbs, minutes drink, anxiety herb, anti anxiety, herbal remedies, treat anxiety, needed tincture, cardiovascular system, heart rate, anti anxiety herb, Herbal Remedies For Anxiety

The study is published in the Oct. 1 issue of the journal Sleep.

Findings suggest that the presence of insomnia in adolescents increases the risk of developing mental health problems and also may increase the severity of these problems.

Results indicate that adolescents who had symptoms of insomnia were 2.3 times more likely to develop depression in early adulthood than adolescents without symptoms of insomnia. Specifically, at baseline, the insomnia group was more likely to use alcohol, cannabis, and non-cannabis drugs, and was more likely to suffer from depression, suic_ide thoughts, and suic_ide attempts. The insomnia group also had a greater risk of developing new incidences of depression and suic_ide attempts after excluding participants who suffered from these specific psychopathologies at baseline.

When excluding participants who endorsed any mental health problem at baseline, the insomnia group was significantly more likely to develop incident depression. In addition, gender differences emerged for alcohol use, cannabis use, non-cannabis drug use, and depression. Independently of insomnia status, males were significantly more likely to endorse alcohol use, cannabis use, and the use of other drugs, while females were twice as likely to develop depression.

“Previous research in adults has found similar results to this study,” said principal investigator and lead author Brandy M. Roane, MS, a doctoral student at the University of North Texas. “The current study suggests adolescents with insomnia are more prone to developing mental disorders, specifically depression.”

Insomnia symptoms were reported by 9.4 percent of the adolescents in the study. Information discovered during this study could potentially provide parents, educators and mentors with a sign of a risk factor for the development of mental health issues.

The study involved 4,494 adolescents between 12 and 18 years of age at the beginning of the study, and 3,582 young adults between the ages of 18 and 25 years in a six-to-seven year follow up. One-hundred and forty-five U.S. middle, junior and high schools were selected to participate based on size, school type, census region, level of urbanization, percentage of Caucasian and African-American students, grade span and curriculum. Health-related variables such as height, weight, pubertal development, mental health status, and chronic and disabling conditions were obtained through in-home interviews and self-report.

Adolescents who reported having trouble falling asleep every day or almost every day were categorized as having insomnia symptoms. Binge drinking was defined as drinking five or more alcoholic beverages in a row, and suic_ide ideation was based on whether or not a participant had endorsed having thoughts of suic_ide in the last year.

(Published at Health News Track on October 2, 2008 – 6 days ago)

Labels:insomnia, study, depression, adolescents

While there is public interest in the United States about whether St. John’s wort adequately treats depression, in some countries, like Germany, doctors commonly prescribe it for mild symptoms. Authors of the review found that studies with German patients did, in fact, have the best results.

“The most striking finding from our review is that trials from German-speaking countries have clearly more positive effects, both compared to placebo and standard antidepressants, than trials from elsewhere,” said lead reviewer Klaus Linde of the Centre for Complementary Medicine Research at Technical University in Munich. “In principle, we can say that hypericum extracts work in German-speaking countries, but we are less certain for other countries.”

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

A person could be experiencing major depression when depression symptoms interfere with his or her ability to work, sleep, eat and take pleasure in activities previously enjoyed. The symptoms usually last for at least two weeks, but can often last longer than several months. St. John’s wort (an extract of the plant Hypericum perforatum L.) is an herbal alternative for patients who do not want prescribed antidepressants.

Exactly how the herb works to treat depression is unclear, partly because the extracts can contain at least seven groups of components, according to the reviewers. There is also no regulation on what the extract must contain.

“There is no patent protection on herbs; therefore, more or less anyone can market hypericum extracts,” Linde said. “The products on the market vary enormously in their quality and content in active ingredients.”

Linde added that consumers should be aware that many St. John’s wort products on the market have very low concentrations (such as dosages of less than 300 milligrams per day), and therefore, probably act only by placebo effects.

In the United States, the National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health, reports that St. John’s wort is “of minimal benefit in treating major depression.” A study co-funded by NCCAM, found St. John’s wort to be no more effective than placebo in treating major depression of moderate severity.

Linde and his colleagues wrote a previous Cochrane review in 2005 on St John’s wort and concluded that it did reduce symptoms of mild to moderate depression. The significant difference between the 2005 review and the current one is the reviewers now include only studies restricted to major depression, while the older version included all depressive disorders.

“Compared to 2005, the evidence that hypericum extracts are effective is better now,” said Linde. “The new version also for the first time shows significantly fewer side effects associated with hypericum extracts compared to selective serotonin reuptake inhibitors.”

The current review evaluated 29 studies from a variety of countries-with 5,489 patients-and all trials were randomized and double blind. The reviewers compared treatment of patients with major depression with extracts of St. John’s wort for four to 12 weeks with either placebo or tri- or tetracyclic antidepressants and selective serotonin reuptake inhibitors.

According to the reviewers, the St. John’s wort products tested in the trials were high- quality products and the daily extract dosages were between 500 and 1,200 milligrams.

The Cochrane reviewers concluded the available evidence suggests that hypericum extracts are superior to placebo in treating patients with major depressions and are “similarly effective” as standard antidepressants.

John Williams, M.D., director of the Duke Evidence-based Practice Center at Duke University and Durham VA Medical Center, has also done research on the use of St. John’s wort for depression and disagreed that patients with major depression should turn to the product.

“Given the inconsistent evidence about efficacy in major depression and the questionable quality of over-the-counter products, St. John’s wort should not be a first or second choice for U.S. patients with moderate to severe major depression,” he said.

Williams added, however, that for patients with minor depression, where the evidence for St. John’s wort “is more robust,” it might be an option for patients who can find quality products.

The review disclosed that each author has received speaking or travel reimbursement fees from German drug manufacturer Schwabe.

(Published at Health News Track on October 8, 2008 – today)

Labels:patients, symptoms, depression, compared, products, treating, moderate, evidence, john, major, extracts, review, hypericum, reviewers, placebo, quality, linde, countries, trials, german, cochrane, antidepressants, market, center

The statement was published in Circulation: Journal of the American Heart Association.- early and repeated screening for depression in heart patients;
– the use of two questions to screen patients — if depression is suspected the remaining questions are asked (9 questions total);
– coordinated follow-up for both heart disease and depressive symptoms in patients who have both.

“The statement was prompted by the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook,” said Erika Froelicher, R.N., M.A., M.P.H., Ph.D., a professor at the University of California San Francisco, School of Nursing and Medicine and co-chair of the writing group.

Dale Briggs, who experienced depression after his heart valve surgery, said the statement is welcome news. “I think it’s long overdue. It is unfortunate that some patients aren’t warned of the possibility of some depression after surgery,” he said.

Briggs is the volunteer executive vice president of Mended Hearts, Inc., a national non-profit organization affiliated with the heart association, offering resources and support for heart surgery patients. He shares his experience with new cardiac patients during hospital visits — one of the main patient-to-patient support services offered by Mended Hearts.

“Since my surgery, I’ve visited about 1,000 patients. During a visit I always let patients know that this may happen, and encourage them to talk to their doctor about getting treatment,” he said. “I’ve had a number of people call me through the years and thank me for warning them about the possibility of depression.”

Experts say depressed cardiac patients have at least twice the risk of second events in the one to two years after a heart attack. Furthermore, studies have shown that more severe depression is associated with earlier and more severe second cardiac events, Froelicher said.

For example, one study found that 15 percent to 20 percent of hospitalized heart attack patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression. An even greater proportion showed more depressive symptoms than usual in the population, though not sufficient to meet these criteria. The study also found that some subgroups of patients, such as young women with heart disease, seem particularly vulnerable to depression.

“Studies show that depression is about three times more common in patients following a heart attack than in the general community,” said Judith H. Lichtman, Ph.D., M.P.H., writing co-chair of the statement and associate professor of epidemiology at Yale University School of Medicine in New Haven, Conn. “Because there has been no routine screening for depression in heart patients, we think there is a large group of people who could benefit from appropriate treatment.”

Although depression was mentioned in earlier American Heart Association scientific statements, this is the first to specifically target the condition. Lichtman said more research is needed to determine why depression is associated with poorer outcomes.

Recent studies indicate that depressed patients are less likely to take their medicines as directed, improve their diets, exercise and attend cardiac rehabilitation sessions, all of which could contribute to a worse outcome, Lichtman said.

It’s also possible that biological changes associated with depression such as reduced heart rate variability and increases in blood factors that encourage clot formation could increase risk, the statement said.

Other recommendations in the statement include:

– Patients who have depressive symptoms should be evaluated by a professional qualified in diagnosing and managing depression, and should be screened for other psychiatric disorders, such as anxiety.
– Treatment options include cognitive behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs or combinations of those treatments.
– Selective serotonin reuptake inhibitor (SSRI) treatment soon after a heart attack is considered safe, relatively inexpensive and may be effective for treating depression.
– Routine screening for depression in coronary heart disease patients should be done in multiple settings, including the hospital, physician’s office, clinic and cardiac rehabilitation center, to avoid missing the opportunity to effectively treat depression in cardiac patients and improve physical health outcomes.
– Coordination of care between health providers is essential for patients with combined medical and psychiatric diagnoses.

“Depression and heart disease seem to be very much intertwined,” Lichtman said. “You can’t treat the heart in isolation from the patient’s mental health.

“There is no direct evidence yet that treating depression improves coronary heart disease outcomes, but plenty of evidence shows that having depression worsens those outcomes. By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it.”

Co-authors include J. Thomas Bigger, Jr., M.D.; James A. Blumenthal, Ph.D., ABPP.; Nancy Frasure-Smith, Ph.D.; Peter G. Kaufmann, Ph.D.; Francois Lesperance, M.D.; Daniel B. Mark, M.D., M.P.H.; David S. Sheps, M.D., M.P.H.; and C. Barr Taylor, M.D. Individual author disclosures are included on the manuscript.

(Published at Health News Track on October 2, 2008 – 2 days ago)

Labels:heart disease, patients, disease, heart, symptoms, depression, lichtman, rehabilitation, evidence, cardiac, cardiac patients, depressive