How is depression treated?

How is depression treated?

There are many treatments for depression. Major depressive disorder may be treated with antidepressants, psychotherapy (supportive counseling or “talk therapy”), or a combination of both. Newer, safer antidepressant medications, such as SSRIs (selective serotonin reuptake inhibitors) have an established safety record and are safe for cardiac patients. The antidepressants sertraline (Zoloft) and citalopram (Celexa) have been the best studied, are effective and safe in patients with heart disease, and also are available in generic forms.

Psychotherapy can increase a person’s social support and help the patient develop more positive thinking patterns. Brief supportive models of talk therapy appear to be the most appropriate for helping the depression that cardiac patients experience.

A healthy lifestyle including regular exercise, proper sleep, a well-balanced diet, as well as relaxation and stress management techniques can help you manage depression. In a recent intervention trial, physical exercise was found to have a significant effect on depression.⁸

Major intervention studies — both pharmacologic (SADHART, CREATE) and psycho-therapeutic (ENRICHD) — have been performed in patients who are clinically depressed after a heart attack. These studies are helping clinicians better understand the link and treatment of depression and heart disease and guide optimal treatments. Patients with a previous history of depression or who are experiencing severe depression can be the best responders to medication intervention.⁹⁻¹⁰⁻¹¹⁻¹²⁻¹³

Last reviewed by a Cleveland Clinic medical professional on 04/29/2019.

References

  1. Reference: Jiang W, Davidson JRT. Antidepressant therapy in patients with ischemic heart disease. American Heart Journal, November 2005. 150(5):871-881.
  2. Reference: Frasure-Smith N, et al. Depression following myocardial infarction: Impact on 6-month survival. JAMA, October 20, 1993. 270(15):1819-1825.
  3. Reference: Nakatani D, et al. Influence of serotonin transporter gene polymorphism on depressive symptoms and new cardiac events after acute myocardial infarction. American Heart Journal, October 2005. 150(4):652-658.
  4. Ruo B, et al. Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA, July 9, 2003. 290(2):215-221.
  5. Gehi AK, et al. Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study. Archives of Internal Medicine, November 2005. 165(2):2508-2513.
  6. Gehi AK, et al. Relation of self-reported angina pectoris to inducible myocardial ischemia in patients with known coronary artery disease: the Heart and Soul Study. The American Journal of Cardiology, September 15, 2003. 92(6):705-707.
  7. Litchman JH, et al. Depression and coronary heart disease: Recommendations for screening, referral and treatment. A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation, Oct 21 2008. 118(17):1768-1775.
  8. Blumenthal JA, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine 2007. 69(7):587-596.
  9. Lesperance F, et al. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA, 2007. 297(4):367-379.
  10. Frasure-Smith N., et al. Design and rationale for a randomized, controlled trial of interpersonal psychotherapy and citalopram for depression in coronary artery disease (CREATE). Psychosomatic Medicine, 2006. 68:87-93.
  11. Glassman AH, et al. Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Archives of General Psychiatry, 2006. 63(3):283-288.
  12. Glassman AH, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA, 2002. 288(6):701-709.
  13. Writing Committee for the ENRICHD Investigators. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease patients (ENRICHD) randomized trial. JAMA, 2003. 289(23):3106-3116.

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