February Meeting at JSUMC

We had two guest speakers today! Our first speaker was pharmacist Lisa Antonacci, RPh, PharmD. She told us that six out of ten heart attack patients have some degree of clinical depression. The AAFP (American Academy of Family Physicians) gives the following recommendations:

• Patients should be screened for depression after heart attack, during recovery in the hospital and after they go home.

• If depression is diagnosed, it should be treated. It is not a natural progression and it can interfere with recovery.

• Psychotherapy can be beneficial in treating depression after heart attack.

• About medications: the older tricyclic antidepressants (such as Elavil, Pamelor and Tofranil) can interact with heart medications; the newer SSRIs (selective serotonin reuptake inhibitors such as Zoloft, Paxil and Lexapro) are preferred.

She didn’t try to describe all the possible interactions between drugs for depression and heart medications. The first thing, she said, is to pick one pharmacy for all your medications, because the pharmacist will be aware of potential interactions.

Then she asked for questions. One person mentioned that about three months after his heart attack, during rehab, he started to experience symptoms that looked like depression, but he suspected that he had an underactive thyroid gland, and a test confirmed it. The hospital then added a thyroid test to their routine post-MI screening. Lisa pointed out that there are many reasons why patients can seem depressed after heart attack, including the side effects of the heart medications themselves.

Other questions touched on seasonal depression in winter, and the use of multiple drugs to treat anxiety as well as depression.

Our second speaker was Adriana Fitzsimmons, MD, a staff physician in psychiatry. She began by noting that people with depression are at higher risk for cardiac illness, and people with cardiac illness are at higher risk for depression.

At least 20 percent of patients with various heart ailments have major depression, two or three times as many as in the general population. They have poor sleep, poor appetite, low motivation, and difficulty keeping up with exercise and medications. They have a sense of hopelessness, they don’t take pleasure from formerly pleasurable activities, and some become suicidal.

Mild depression can appear as sadness, crying more, feeling less motivated, negative outlook about recovery, less appetite, not sleeping so well, or feeling anxious.

Major depression is a big risk factor for cardiac morbidity and mortality. If untreated it can affect the physical outcome. Recovery can be delayed, and the risk of cardiac events like arrhythmias, strokes, and heart attacks increases.

Whether you have depression, and how severe it is, can be measured by a depression score, derived from a questionnaire that the patient fills out. Dr. Fitzsimmons showed a graph of five year cardiac mortality vs. depression score, and the more severe the depression, the greater the mortality, ranging from about 7 percent for the lowest depression scores to over 26 percent for the highest. Another graph showed decreased one-year survival after unstable angina for patients with higher depression scores.

How does depression increase cardiac risk? People with depression have increased platelet functioning, so they are more apt to form blood clots that clog arteries. Their inflammatory factors are higher. But they also are harmed by failure to keep up with exercise, diet and medications.

A lot of work still has to be done. Less than 25 percent of cardiac patients with major depression are correctly diagnosed, and of those only about half get treatment. Cost-effective methods of screening and treatment are still being worked out.

One problem is that medications for depression take weeks to take effect, so they must be taken even if they don’t seem to be helping, and when stopped they take weeks to lose effect, so the patient may think the medication isn’t needed any more when in fact it still is.

Dennis Broschart, who is the Volunteer Coordinator at Jersey Shore and a past acting co-president of our chapter, had some comments to make. When a patient is taking medication, and the medication is working, the patient isn’t aware that the medication is needed. And people sometimes refuse to admit they’re depressed because they know they ought to feel glad they’ve survived a cardiac event, and being depressed would be ungrateful. There’s that conflict between being a heart patient and being depressed.

Chapter President Bill Ryan had some further comments. Different doctors prescribe different medications and they don’t always give correct advice on how to get off them; there can be a rebound effect if you stop abruptly. Patients need to get information from the library at Jersey Shore or their public library, they should not hesitate to go for a second opinion, they need as much information as they can get

The final business at the meeting was the elections for Mended Hearts national offices. Last month’s newsletter announced that this was a special election meeting and included a mail-in ballot. Ballots were handed out to members at the meeting and votes were collected. The chapter has one vote, based on the results of the voting within the chapter. I won’t tell you what the chapter result was because it’s just one vote out of many. The final result will appear in Heartbeat, the national Mended Hearts newsletter.

Meanwhile, Bill announced that his wife works at Fort Monmouth, and if it closes, which is scheduled to happen in 2011, he will move to Maryland and we will need a new chapter president.