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Diagnosis and Treatment of Depression in Patients With Congestive Heart Failure: A Review of the Literature

James K. Rustad, MD; Theodore A. Stern, MD; Kathy A. Hebert, MD, MMM, MPH; and Dominique L. Musselman, MD, MSCR

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ABSTRACT

Context: Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure.

Objective: We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure.

Data Sources: A PubMed search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression.

Study Selection: We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus.

Data Extraction: The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined.

Results: MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart failure, particularly in those patients with coronary artery disease , and is associated with a poorer quality of life, increased use of health care resources, more frequent adverse clinical events and hospitalizations, and twice the risk of mortality.

Conclusions: At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy.

Prim Care Companion CNS Disord 2013;15(4):doi:10.4088/PCC.13r01511

Submitted: February 7, 2013; accepted April 12, 2013.

Published online: August 15, 2013.

Corresponding author: James K. Rustad, MD, Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, 3515 E Fletcher Ave, Tampa , FL 33613 (jkrustadmd@knights.ucf.edu).