Picking up elevated symptoms of depression in MI patients can be critical for their self care
It’s no secret that patients with cardiovascular disease are more likely to be depressed, and patients with depression are more likely to have cardiovascular problems, but a major factor causal factor could be non-adherence to medication, a leading health psychologist says.
Audience members at the Australasian Society for Behavioural Health and Medicine and Australian Psychological Society conference this month were encouraged to pay special attention to the mental health of cardiovascular disease patients.
“There is sort of a chicken and egg problem between medication non-adherence and depression, that is, which comes first?” Professor Karina Davidson, a professor of behavioural medicine at Columbia College of Physicians and Surgeons, and the director of the Center for Behavioral and Cardiovascular Health, told The Medical Republic.
Research shows that medication non-adherence is twice as high in depressed patients with cardiovascular disease compared with non-depressed patients.
“But when we track patients across time we see that for those patients whose depression improves, their medication adherence improves, but for those patients whose medication adherence improves, it does not touch their depression,” Professor Davidson said.
“So that’s led us to believe if we’re going to help them with their self-care, we need to tackle their depressive symptoms.”
Mild forms of depression are found in up to two-thirds of patients hospitalised after acute myocardial infarction and major depression is found in around one in six patients with cardiovascular disease, research suggests.
The magnitude of risk that depression conferred was similar to many of the other standard cardiovascular risk factors, such as high blood pressure, cholesterol or being overweight, but it was not quite as large as smoking, Professor Davidson said.
Depressed patients have worse outcomes too, with a risk of death after an acute myocardial infarction three-fold higher than for non-depressed counterparts.
“We believe that [non-adherence] is one of the mechanisms of action by which depression actually confers excess risk for death in post-MI patients,” Professor Davidson said.
Her research suggested patients suffering from depressive symptoms, such as anhedonia, fatigue and problems concentrating, often struggled with adopting all of the new behaviour activities they were requested to do.
“We ask them to take as many as 11 medications daily, many of them not twice a day but maybe three times a day, and one of them twice a day, and four of them daily, and one of them only after meals and another one only in the morning,” Professor Davidson explained.
“And we ask them to change their smoking habits, we ask them to start exercising, we ask them to moderate their alcohol, and we ask them to change their diet. And that’s adhering to an awful lot of changes in their life that can really be hard when you’re not feeling well.”
Professor Davidson strongly recommended all patients be screened for depression with a standardised tool following a myocardial infarction.
This was because it could be tricky to pick up on elevated depressive symptoms following acute myocardial infarction, “because, of course, they’re tired, they’re having some memory problems, they’re somewhat pessimistic of the future – that seems like a normal course post-MI”.
“What we recommend is that if you notice that your patient is showing either depressed mood or anhedonia after a heart attack, then you should think of this patient as someone who is somewhat compromised in their ability to enact self-care.
“Anything you can be doing to support that patient in taking their needed medication as prescribed will surely be helpful to that patient.”
