March 22, 2012

Service helps heart attack patients overcome depression

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Vidya Raj, M.B., Ch.B., works to treat patients who experience depression following a heart attack or other severe cardiac event. (photo by Anne Rayner)

Service helps heart attack patients overcome depression

Depression is three times more common in patients who suffer a heart attack than in the general population and is associated with higher cardiovascular morbidity and mortality, according to an American Heart Association Science Advisory.

Enter Vidya Raj, M.B., Ch.B., assistant professor of Psychiatry, and an attending psychiatrist on the Consultation-Liaison Psychiatry Service. Her research interests include electroconvulsive therapy, mood disorders in patients with cardiac disease and autonomic dysfunction.

“After you have had a heart attack or heart failure, your quality of life is particularly bad. There’s been a lot of research in cardiology and psychiatry on the outcomes with depression in cardiac patients,” she said.

“If you are depressed after an acute cardiac event or with heart failure, you are two to three times as likely to die in subsequent years as someone who isn’t.”

There are many lines of research looking into what the relationship is between coronary heart disease and depression. Depression can increase inflammation in the body, and in blood vessels this can increase a patient’s tendency to clot. In addition, a depressed patient is less likely to look after himself, to quit smoking, to participate in cardiac rehab or to change his diet.

“There is a psychological aspect to it where people were very productive and then they have a heart attack, and they sense a loss. There is a relationship between the severity of a heart attack, how much of a disability you are left with, and how depressed you get. People talk about suddenly realizing their own mortality. All of these factors are linked with depression,” Raj said.

Clinicians can screen heart failure patients and acute coronary syndrome patients for depression using a free patient health questionnaire in Star Panel using a Star Form called PHQ-9. If a patient scores 10 or higher, they should receive a formal evaluation from a mental health professional.

The results of the questionnaire are entered into the Vanderbilt Heart Registry database developed by Daniel Lenihan, M.D., director of the Cardiology Clinical Research Program.

Although cardiac patients are of particular interest to Raj (her father suffered from heart disease and she is married to Vanderbilt Heart cardiologist Satish Raj, M.D. MSCI), she consults on all adult inpatient services.

Brian Allred, 30, was referred to Raj in 2010. He was suffering from anxiety attacks and depression after battling back-to-back health issues in 2009 and 2010 that left him unable to care for his newborn daughter or work.

“I was in and out of the hospital so many times during that two-year span,” said Allred, who was diagnosed with Hodgkin’s Lymphoma in 2010 after battling autoimmune autonomic ganglionopathy prior to that.

Through a combination of talk therapy and medication, Raj was able to help Allred get his anxiety and depression under control.

“I don’t want to imagine where I’d be without being able to talk with Dr. Raj,” said Allred, who is a graphic designer in Columbia, Tenn. “Having that outlet to talk to someone and have someone who understands my problems and treats them – I can’t express how grateful I am.”

Raj and the Psychiatry Consultation-Liaison team, led by John Shuster, M.D., see adult inpatients for problems like delirium, agitation, overdoses, suicide attempts, and often to evaluate their ability to make medical decisions.

But, the most common problem is depression.

“We consult on other services such as cancer, urology, burns, trauma, ObGyn, pretty much every type of patient except children.

“The heart patient is unique; there is such strong research that shows that they are more likely to die if you don’t adequately treat the depression,” Raj said.