"Probably only half of the physicians who treat heart failure patients feel comfortable about treating patients for their depression," Jiang said. "Also, those physicians that do prescribe antidepressants shouldn't just write the prescription and see the patients three or six months later."
Not only should more physicians treat their depressed patients for their disease, or at least refer them to a specialist for treatment, but physicians also should ensure that the patients receive adequate follow-up attention, Jiang said.
"Physicians need to know if their patients are experiencing side effects of their medication, or if the initial dose is correct," she said. "In some patients, it can take some time finding the right antidepressant and the proper dose. Also, treating physicians need to know that their patients are continuing to take their medications, and that requires regular follow-up."
Although this and other studies have demonstrated links between depression and worse outcomes for patients with cardiovascular disease, the mechanisms behind the correlation are not well understood, Jiang said. Among possible factors, depressed patients are known to have overly active immune systems, a decrease in the ability of their blood platelets to clot properly and a decrease in their heart's ability to react appropriately to the stresses of everyday life, she said.
"We also know that depressed patients tend not to comply with their treatments, are not as motivated to stick with exercise or rehabilitation programs, and often miss doctor's appointments" Jiang said. "Also, depressed patients tend to make unhealthy lifestyle choices in such areas as diet and smoking."
Jiang said she
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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
13-Nov-2006