Identify and treat depression for reduced cardiac risk and improved outcomes

Abstract

Why do we stay in prison when the door is wide open? - Jalal ad-Din Rumi. Depression is an independent risk factor for the development of CAD. Patients with CAD have a high rate of depression, which worsens their prognosis. Screening CAD patients with the 2-question PHQ-2 to identify those at greatest risk of depression is strongly recommended, as is referring patients for further evaluation and possible treatment when depression has been identified by the PHQ-9. Treating depression is likely to improve cardiovascular outcomes. The PHQs are in the public domain and free to use. To download and for more information, visit www. phqscreeners.com.

Keywords: Antidepressive agents; comorbidity; coronary disease/prevention & control; depressive disorder/complications/diagnosis/drug therapy/epidemiology.

Figures

Fig. 1 The Patient Health Questionnaire-2 (PHQ-2) is a simple 2-question assessment that has been validated to identify currently depressed patients. Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display, or distribute.

Fig. 2 The Patient Health Questionnaire-9 (PHQ-9) is a 5-minute, 9-question screening test that is administered in response to a PHQ-2 response score of 3 or higher. The PHQ-9 provides a provisional diagnosis of depression and a severity score that imparts reasonable sensitivity and specificity. A score greater than 10 suggests a high probability of depression, and scores greater than 20 are associated with severe functional impairment. Patients with scores over 10 should be referred for a more comprehensive evaluation and treatment plan. Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display, or distribute.