Heart Failure: Psychological and Pharmacological Considerations

Among patients with heart failure (HF), depression and anxiety disorders are common and associated with poor functioning, frequent hospitalizations, and increased rates of mortality. Despite these associations, depression and anxiety disorders are underdiagnosed and undertreated in this high-risk cohort. Diagnosing depression or anxiety disorders in patients with HF is challenging due to the overlap between cardiac and psychiatric symptoms. We recommend diagnosis through the use of a clinical interview and adherence to the Diagnostic and Statistical Manual of Mental Disorders , fifth edition, criteria. Once a psychiatric diagnosis is confirmed, both pharmacological and psychotherapeutic interventions are available. Selective serotonin reuptake inhibitors are well-tolerated in patients with cardiovascular disease but have limited efficacy in patients with HF. Cognitive-behavioral therapy improves mental health outcomes in patients with HF but has not been shown to improve physical health. Finally, collaborative care programs may be considered for the management of uncomplicated depression and anxiety disorders. [ Psychiatr Ann . 2016;46(12):691–701.]