Doctors rethink care with depression, heart link connection

WASHINGTON — He was the head of a big health care conglomerate in Florida, and a well-known emergency physician. But something happened after Dr. Nabil El Sanadi had open-heart surgery in mid-January. Ten days later, he committed suicide.

“That is an unfortunate event, and it is all too common,” says Dr. Allen Taylor, chief of cardiology at the MedStar Heart and Vascular Institute.

He says about 40 percent of heart disease patients suffer from depression, emphasizing “it is extremely important to detect.”

It is important for several reasons.

Taylor says a history of depression doubles the risk of future heart problems, and then can make the condition worse.

It can surface after a heart episode or surgery, complicating and slowing the path to recovery.

Taylor says there is really a strong connection between the heart and the mind. He notes people who are depressed often make poor lifestyle choices, and don’t eat or exercise the way they should for heart health.

Just as worrisome for physicians is the direct physical toll depression can take on the body.

“There are things like how your blood clots, how your body handles inflammation, how your body responds to stress that change when you are depressed,” says Taylor.

Perhaps that is why in cardiology — as in the treatment of cancer — doctors are taking what some would call a more holistic approach, looking for signs of a troubled mind that might impact the heart.

Taylor says there are simple screening methods that, while not a complete diagnosis, can uncover indications of depression that need follow-up.

He says for doctors, that often means just returning to the basics, adding “you have to know your patient, you have to watch, you have to listen.”

There is a role that family members can play in the screening process, because they see the patient on a regular basis.

Taylor points to a simple two-question screening tool for depression that is readily available online called the PHQ-2. It’s been around for almost two decades and has the backing of the American Psychological Association. Again, the aim is not to make a formal diagnosis, but to pick up on possible causes for concern.

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