Assessment and Treatment of Depression in Patients With Cardiovascular Disease: National Heart, Lung, and Blood Institute Working Group Report

Objective: The National Heart, Lung, and Blood Institute convened an interdisciplinary working group of experts to develop recommendations for the assessment and treatment of depression in patients with coronary heart disease (CHD). Method: Consensus of experts. Results: Our current recommendations are that the Beck Depression Inventory-I be employed for epidemiological studies of depression and CHD, that the Patient Health Questionnaire 2-item version be employed for screening for trial eligibility, that the Depression Interview and Structured Hamilton (DISH) be employed for diagnostic ascertainment for trial inclusion, and that the Hamilton rating scale, which is part of the DISH, be employed for both depression symptom reduction and the remission criterion in any trial. We further recommend that a randomized controlled trial be undertaken to determine whether selective serotonin reuptake inhibitors, psychotherapy, or combined treatment can reduce the risk of CHD events and mortality associated with depression in CHD patients. Conclusions: This report summarizes the recommendations made by the working group and discusses the rationale for each recommendation, the strengths and weaknesses of alternative approaches to assessment and treatment, and the implications for future research in this area. ACS = acute coronary syndrome; BDI = Beck Depression Inventory; CBASP = Cognitive Behavioral Analysis System of Psychotherapy; CBT = cognitive behavior therapy; CIDI = Composite International Diagnostic Interview; CHD = coronary heart disease; CVD = cardiovascular disease; DISH = Depression Interview and Structured Hamilton; ENRICHD = Enhancing Recovery in Coronary Heart Disease; HAM-D = Hamilton Rating Scale for Depression; IDS-SR = Inventory of Depressive Symptomatology, self-report; IMPACT = Improving Mood–Promoting Access to Collaborative Treatment; IPT = interpersonal therapy; MI = myocardial infarction; NHLBI = National Heart, Lung, and Blood Institute; PHQ = Patient Health Questionnaire; RCT = randomized controlled trial; SADHART = Sertraline Antidepressant Heart Attack Randomized Trial; SCID = Structured Clinical Interview for DSM-IV; SSRI = selective serotonin reuptake inhibitor; STAR*D = Sequenced Treatment Alternatives to Relieve Depression.