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Cardiac Patients, Take Heart

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Aug. 13, 2001 -- Adding to a growing body of evidence that depression can worsen heart disease, a new study shows that people with heart failure and depression fare much worse than their depression-free counterparts.

Reporting their findings in the Aug.13 issue of the Archives of Internal Medicine, Duke University researchers found that people with heart failure and depression are about twice as likely to die or to be readmitted to the hospital in the ensuing year, compared to those with heart failure who are not depressed.

People shouldn't get depressed if they have heart failure, says study author Wei Jiang, MD. But if you do feel down and are not interested in getting on with life, she advises you seek help because the depression will shorten life or put you back in hospital.

Jiang is a senior resident in the medicine and psychiatry training program at Duke University Medical Center in Durham, N.C.

About five million people in the U.S. have heart failure, a disease that occurs when the heart can't pump enough blood to meet the needs of the body's other organs. Many different problems can cause it, including a heart attack, narrowed arteries, high blood pressure, or congenital heart defects.

The "failing" heart keeps working but doesn't work as efficiently as it should. As a result, people become short of breath and tired when they exert themselves. Swelling in the body and ankles may occur when blood flow out of the heart slows and blood returning from the veins backs up.

Patients with heart failure or their families should tell the cardiologist or primary care doctor if they suspect depression, says Jiang, unless a psychiatrist already is part of the treatment team. In that case, the concerns might be taken to that physician directly.

People with heart failure often are taking at least four medicines, and according to Jiang, no information from clinical trials has shown if it's OK to add an antidepressant to the mix. But, she recommends starting with a newer class of antidepressants, called selective serotonin reuptake inhibitors, such as Prozac and Zoloft, because they tend to interact less with other medications.

To assess whether you're depressed, ask yourself these questions:

  • Over the past couple of weeks, have you been feeling blue or down most of the time or feeling sad for unknown reasons?
  • Have you lost interest in doing the things that you used to enjoy?
  • Are you experiencing problems sleeping? Do you sleep too much? Too little? Do you awake frequently during the night and have trouble falling back to sleep? Are you tired even when resting?
  • Do you get upset or angry at minor things?

If you answer "yes" to the above questions, talk to your doctor. You may be depressed.

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