Dr. Silvertooth is skilled in the diagnosis and treatment of psychiatric
symptoms in individuals with other medical problems, such as (but not
limited to):
Thorough psychiatric evaluation.
Routine medication follow up visits.
Complete assessment of all medications for possible drug
interactions, psychiatric side effects.
Short term individual psychotherapy.
(“talk” therapy)
Physical examination (as needed).
Laboratory and xray testing (as needed).
Collaboration with referring physicians and consultants.
Limited primary care depending on individual needs.
|
 Depressed individuals
have 1.5 - 2 times increased risk of heart disease or
cardiovascular death.
Individuals with heart
disease and depression have 3-4 times greater risk for death than those
individuals with only heart disease.
20% of heart disease patients have depression
Up to 30% of patients following bypass surgery or who have heart failure
have depression.
Psychological
effects play a role:
 Concerns about losing
autonomy, control of health, ability to
..provide for others, becoming
dependent on others
Fears about death
Fears about losing
loved ones, relationships
Loss of self esteem
Significant
denial of illness can lead to not taking care of
..medical problems
Medications
for cardiovascular disease can cause symptoms similar to depression
as well as depression itself. Examples of drug classes that can contribute
to symptoms of depression include the following:
Beta blockers (fatigue)
Diuretics
ACE inhibitors
Digoxin
Neurochemical
and inflammatory changes in the body: similar changes occur in both
depression and heart disease, possibly resulting in the onset or exacerbation
of either of these illnesses:
Elevated inflammatory
markers, such as C-Reactive Protein
.. (CRP) and
interleukin 6
Platelet serotonin
dysfunction
Worsens platelet
stickiness in the blood, possibly accounting for
increased blockages in the heart vessels
Serotonin dysfunction
is a key factor in depression
Neurochemical
and inflammatory changes as mentioned above
Changes
in blood pressure and pulse rate measures
Decreased
adherence to treatment:
Individuals with
depression are less likely to quit smoking,
.. exercise,
maintain healthy diet, take medications regularly.
This does not
account for the entire effect that depression
.. has
on cardiovascular disease, only part.
Depression or sadness is often perceived as being an
‘understandable’ reaction to illness, leading to under-diagnosis
and under-treatment.
Symptoms of depression are often similar to symptoms of heart disease,
such as fatigue, poor appetite, and poor sleep. This makes diagnosis
of depression challenging.
Must look for loss
of interest in previously pleasurable activities, sadness, irritability,
thoughts about death or wanting to die.
Depression is the 2nd
leading cause of disability (1st is heart disease), leading to significant
numbers of days lost from work.
Depressed heart patients
have markedly increased mortality rates, as mentioned above.
Depressed heart patients
are more likely to report significantly poor quality of life, symptom
burden from heart disease, physical limitations, and poor overall health.
In depressed heart
failure patients, depression was the strongest predictor of decline
in health
Individuals with depression
have by far much more utilization of health care resources, including
increased visits to primary care doctors and ERs for physical complaints,
as well as increased rates of hospitalizations.
Antidepressant medications,
particularly the newer SSRIs (selective serotonin reuptake inhibitors,
such as fluoxetine, paroxetine, sertraline) are often used.
Unfortunately there are a number of older psychiatric medications
that are considered to be unsafe in heart patients, such as the tricyclic
antidepressants and MAO inhibitors. Physicians must be aware of the
safe medication options as well as possible drug interactions prior
to starting antidepressant therapy for heart patients.
Psychotherapy or “talk therapy” is often effective.
ECT (electroconvulsant
therapy) is usually reserved for severely depressed individuals and
can be used in heart patients, however special evaluation and monitoring
is required prior to initiation of the therapy.
|
