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Assessment and Treatment of Depression in Patients With Cardiovascular Disease: National Heart, Lung, and Blood Institute Working Group Report

From the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (K.W.W.¹, J.T.B.,¹ A.H.G.²); Cardiovascular Institute (K.W.W.¹) and Department of Psychiatry (K.W.W.,¹ N.R.¹), Mount Sinai School of Medicine, New York, NY; Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA (D.J.K.,² E.F.²); Behavioral Medicine and Prevention Research Group, National Heart, Lung, and Blood Institute, Bethesda, MD (S.M.C.,² P.G.K.¹); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M.C.²); Department of Psychiatry, Behavioral Medicine Center, Washington University School of Medicine, St. Louis, MO (R.M.C.,² K.E.F.¹); Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA (J.C.C.¹); Department of Psychiatry and School of Nursing, McGill University, Montreal; the Montreal Heart Institute Research Center, Montreal; Centre Hospitalier de l'Universite de Montreal Research Center, Montreal; Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada (N.F.-S.¹); School of Nursing, University of California San Francisco, San Francisco, CA (E.S.F.²); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA (W.J.K.²); Department of Health Care Policy, Harvard Medical School, Boston, MA (R.C.K.¹); Department of Psychiatry and Behavioral Science, Stanford University, Stanford, CA (H.C.K.¹); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (K.R.R.K.¹); Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada (F.L.²); Division of Cardiovascular Medicine, University of Florida, and Malcom Randall VA Medical Center, Gainesville, FL (D.S.S.²); Department of Psychology, University of Iowa, Iowa City, IA (J.M.S.¹).

Address correspondence and reprint requests to Karina W. Davidson, PhD, Department of Medicine, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH9 Center, Room 941, New York, NY 10032. E-mail: kd2124{at}columbia.edu

Objective: The National Heart, Lung, and Blood Institute convened an interdisciplinary working group of experts to develop recommendations for the assessment and treatment of depression in patients with coronary heart disease (CHD).

Method: Consensus of experts.

Results: Our current recommendations are that the Beck Depression Inventory-I be employed for epidemiological studies of depression and CHD, that the Patient Health Questionnaire 2-item version be employed for screening for trial eligibility, that the Depression Interview and Structured Hamilton (DISH) be employed for diagnostic ascertainment for trial inclusion, and that the Hamilton rating scale, which is part of the DISH, be employed for both depression symptom reduction and the remission criterion in any trial. We further recommend that a randomized controlled trial be undertaken to determine whether selective serotonin reuptake inhibitors, psychotherapy, or combined treatment can reduce the risk of CHD events and mortality associated with depression in CHD patients.

Conclusions: This report summarizes the recommendations made by the working group and discusses the rationale for each recommendation, the strengths and weaknesses of alternative approaches to assessment and treatment, and the implications for future research in this area.

Key Words: depression • cardiovascular diseases • assessment • treatment • consensus • recommendations

Abbreviations: ACS = acute coronary syndrome; BDI = Beck Depression Inventory; CBASP = Cognitive Behavioral Analysis System of Psychotherapy; CBT = cognitive behavior therapy; CIDI = Composite International Diagnostic Interview; CHD = coronary heart disease; CVD = cardiovascular disease; DISH = Depression Interview and Structured Hamilton; ENRICHD = Enhancing Recovery in Coronary Heart Disease; HAM-D = Hamilton Rating Scale for Depression; IDS-SR = Inventory of Depressive Symptomatology, self-report; IMPACT = Improving Mood–Promoting Access to Collaborative Treatment; IPT = interpersonal therapy; MI = myocardial infarction; NHLBI = National Heart, Lung, and Blood Institute; PHQ = Patient Health Questionnaire; RCT = randomized controlled trial; SADHART = Sertraline Antidepressant Heart Attack Randomized Trial; SCID = Structured Clinical Interview for DSM-IV; SSRI = selective serotonin reuptake inhibitor; STAR*D = Sequenced Treatment Alternatives to Relieve Depression.

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