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10 May 2006
Depression in patients with congestive heart failure (CHF) is not always persistent, says a US researcher who found that minor depression tended to resolve soon after discharge, but that major depression is likely to require treatment.
"Because there are almost no data on the course of depression in inpatients with CHF, we do not know which of the many patients with depression during hospitalization need specific treatment or specialized psychiatric care," notes Harold Koenig, from Duke University Medical Center in Durham, North Carolina.
Over a 24-week period, he followed-up 473 inpatients aged over 50 years who had CHF and depression. Among the participants, 247 had minor depression and 157 had major depression.
In all, 64.0% of patients with minor depression went into remission after an average follow-up of 11.3 weeks, while 47.8% of patients with major depression achieved remission after a follow-up of 20.2 weeks.
Patients with minor depression were more likely to achieve remission sooner if they had less severe depressive symptoms and fewer comorbid medical illnesses, as measured on the Hamilton Depression Rating Scale and the Charlson Comorbidity Index.
Patients with minor depression who were younger, had better physical functioning, and those not treated with antidepressants also tended to go into remission faster.
Thus, remission for patients with CHF and minor depression appears to be related to both the degree of vulnerability and the degree of stress, says Koenig.
For major depression, however, the outcome appeared to be much more affected by intrinsic vulnerability.
Remission in these patients was predicted by less severe depression, being younger, male, and having no history of depression and fewer comorbid disorders. Stress from physical health problems appeared to have less impact on the course of major depression than on minor depression.
Koenig concludes in the Archives of Internal Medicine: "Clinicians should be aware that minor depression is related more to the patient's current medical condition and will resolve soon after discharge in two thirds of cases."
He adds: "For those with major depression, whose depression may be driven more by an inherent vulnerability and less likely to resolve soon after hospital discharge, consideration should be given to treatment.
"If patients are already receiving treatment and symptoms remain severe, then immediate psychiatric consultation is indicated."
Source: Arch Intern Med 2006; 166: 991-996
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