Use Caution in Treating Depressed Cardiac Patients

By Bates, Betsy | Clinical Psychiatry News, July 2001 | Go to article overview

Use Caution in Treating Depressed Cardiac Patients


Bates, Betsy, Clinical Psychiatry News


TUCSON, ARIZ -- Physicians must weigh delicate risks and benefits when treating patients with both serious cardiac disease and psychiatric disorders, paying careful attention to medication interactions and side effects, Dr. John S. Jachna said at a psychopharmacology conference sponsored by the University of Arizona.

As with any medically ill patient, apparent psychiatric symptoms should be analyzed carefully since some may mask underlying physical conditions. A central nervous system infection may cause psychosis, and what appears to be depression may be a sign of vascular cerebral lesions.

Once a psychiatric diagnosis is made, nonpharmacologic options such as psychotherapy may be the best option for a seriously ill patient taking numerous medications. Some form of therapy can be warranted if a cardiac patient is depressed, said Dr. Jachna of the department of clinical psychiatry at the university.

"Untreated depression in patients with myocardial infarction or cardiac disease can be one of the worst associated symptoms contributing to mortality--even more than some of the other potential contributors like arrhythmias and congestive heart failure," he commented.

At one time, the cardiac risks associated with tricyclic antidepressants made physicians reluctant to treat depression- even when they recognized it. Fortunately, newer, safer alternatives allow for treatment soon after an Ml or in the face of complex, longstanding cardiac disease.

"We do have to be aware of the orthostatic hypotension problems that can occur with a lot of our medications because they can be additive, not only to the patient's medical illness but also [because] they marned.

That said, a number of antidepressants are good options for cardiac patients.

Bupropion, for example, has no significant cardiac effects and is often Dr. Jachna's choice for medically ill and depressed patients. …

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