Identifying and treating depression in patients with heart failure

Depression is a common comorbid condition in patients with heart failure (HF) that often goes undiagnosed and untreated. Unless symptoms of depression are specifically looked for, they can be easily missed or mistaken for HF. Clinical depression is a syndromal diagnosis based on patient history, the report of signs and symptoms, and the exclusion of competing diagnoses. This article describes the recommended strategies for recognizing and diagnosing depression. General, psychotherapeutic, and pharmacological approaches to treatment of depression in HF are also discussed. General treatment measures include optimization of medical therapy, patient education, exercise, social support, and family care. Although there are many types of psychotherapy, cognitive-behavioral therapy is particularly appropriate for patients with HF and is described in this article. Categories of antidepressant drugs, including serotonin reuptake inhibitors, tricyclic antidepressants, and miscellaneous antidepressants, are reviewed relative to treating depression in patients with HF. Given the high prevalence and adverse impact of untreated depression in patients with HF, it is essential for advanced practice nurses to develop the requisite knowledge and skills for the identification and treatment of depression.