|
|
||||||||||
|
J Am Coll Cardiol, 2007; 49:1504, doi:10.1016/j.jacc.2007.01.023
(Published online 20 March 2007). © 2007 by the American College of Cardiology Foundation |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
* Veterans Affairs San Diego Healthcare System, Psychology Service (116B), 3350 La Jolla Village Drive, San Diego, California 92161 (Email: Thomas.Rutledge{at}va.gov).
Although our review primarily focused on rates and prospective significance of depression in HF patients, we would like to use Dr. Persauds comments as a platform to make several specific suggestions concerning applications to treatment.
First, treating and understanding depressions effects on HF patients begins at the stage of symptom recognition, a surprisingly difficult task. Depression is notoriously underrecognized in medical patients. The clinical presentations of HF and depression are often similar, complicating diagnosis and assessment of treatment benefits. Social stigmas against mental health diagnoses can make patients reluctant to acknowledge depressive symptoms. Depression may delay treatment-seeking behaviors in some, while increasing health care utilization in others. Depression symptoms can also vary widely across patients, and the meaning of these differences for HF is not known. Collectively, these factors undermine and may even argue against the application of standardized depression treatments in HF populations.
Second, efficacious treatments for depression are still lacking, despite the development of state-of-the-art pharmacotherapies. A substantial patient population does not respond and/or maintains clinically significant symptoms despite treatment attempts (2), and responsiveness may itself have prognostic importance (3).
Third, the presence of depression is not random; rather, it is disproportionately diagnosed among patients who are female, those suffering more advanced disease, those who are socially isolated, and those of lower socioeconomic status. These factors can affect patients presenting symptoms, their ability or willingness to participate in treatment, their responsiveness to treatment, and their susceptibility to relapse.
Our review found the treatment literature for depression in HF to be poorly developed and methodologically inconsistent. At this early stage of researchand lacking any conclusive treatment evidence for survival or event outcomes from the much larger coronary artery disease literaturewe believe it would be imprudent to call for clinical trials in HF at this time. Instead, we hope that our findings and insights from colleagues such as Dr. Persaud can be used to advance the treatment research in this area for potential future applications.
| References |
|---|
|
|
|---|
Related articles in JACC:
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |