updated
4:00 p.m. ET, Mon., Sept. 29, 2008

DALLAS - Heart patients should be regularly screened for
signs of depression, the American Heart Association recommended Monday.

Depression is about three times more common in heart
attack survivors and those hospitalized with heart problems than the general
population, according to the recommendations published in the journal
Circulation. The authors said only about half of heart doctors say they treat
depression in their patients — and not all those diagnosed with depression are
treated.

“I
think we could reduce considerable suffering and improve outcomes,” by
screening, said Erika Froelicher, professor of nursing at the University of
California, San Francisco. “I know we can do more.”

Anyone from cardiologists to nurses to primary care
doctors can and should be involved in determining whether a patient is
depressed, said Froelicher, who was co-chair of the panel that wrote the
recommendations.

Standard questions
The panel suggests that heart patients be screened by first
asking two standard questions: In the past two weeks, have you had little
interest or pleasure in doing things? Have you felt down, depressed or hopeless?

If
the patient answers yes to one or both, a questionnaire is recommended to
determine if the patient is depressed and the severity. If depression is
indicated, the patient may need to see a professional qualified in treating
depression, the panel said, adding that treatment options include
antidepressants, seeing a psychotherapist and exercise.

“Some physicians are qualified to treat it — others may
be more comfortable referring the problem to a qualified mental health
professional,” Froelicher said.

Psychiatrist Michelle Riba said the statement’s emphasis
on frequent screening is important.

“What you want to see in a particular patient is how they
do over time,” said Riba, past president of the American Psychiatric
Association, which has endorsed the heart association’s recommendations.

One doctor said screening isn’t enough; patients need
close monitoring to make sure they get help.

“A
lot of patients with depression don’t follow up on it,” said Dr. Mary Whooley, a
professor of medicine at the University of California, San Francisco, who was
not on the panel.

Barbara Forman, 62, struggled with depression after her
double bypass about five years ago. She said she spent most of her time at her
Englewood, Ohio, home sitting in her chair, frequently crying for no reason.
When she did get out, she was often winded, even from a walk up a sidewalk to
deliver cupcakes to her grandchild’s classroom.

“I’m thinking, is this the way it’s going
to be for the rest of my life? Since I’ve had a heart event, is my life over?”
she said. “It also made me afraid to do things. I didn’t know how a heart attack
felt. I would think, ’Is this a heart attack?”’

A
couple of months after she got home she called Mended Hearts, a group affiliated
with the heart association that provides support to heart patients, and talked
to someone who let her know depression was common in heart patients.

Her family doctor sent her to a psychologist, and after
some initial reluctance, she started taking an antidepressant. That, along with
starting a walking routine and volunteering with Mended Hearts and the heart
association, improved her outlook.

“You can’t sit in your house and just vegetate,” she
said. “Over the last 18 months to two years — It’s really gotten better.”