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Treatment of Depression in Patients with Coronary Heart Disease

      To the Editor:
      Vieweg and colleagues provide excellent updates on treating depression in patients with coronary artery disease. Their practical approach, however, leaves out an important intermediate step.
      For the primary care physician with a large number of patients with possible depression, some confirmatory testing of patients identified on a 2-question screen would be appropriate. In my family practice residency program, we used the 2-question screen and subsequent test with Patient Health Questionnaire-9 as a screening tool for confirmation. The Patient Health Questionnaire-9 is a well-validated, convenient, and easy-to-apply tool to screen depression and score the severity. It also has the best positive likelihood ratio and positive predictive value compared with the other commonly available screening instruments.
      • Vieweg W.V.R.
      • Julius D.A.
      • Fernandez A.
      • et al.
      Treatment of depression in patients with coronary heart disease.
      I recommend that all primary care providers and even cardiologists use this convenient tool that can improve the care of patients with depression.
      • Nease Jr, D.E.
      • Maloin J.M.
      Depression screening: a practical strategy.
      US Preventive Services Task Force recommendations state that “screening improves the accurate identification of depressed patients in primary care settings and that treatment of depressed adults identified in primary care settings decreases clinical morbidity.”
      • Gary Ruoff
      A method that dramatically improves patient adherence to depression treatment.

      Screening for depression. Release date: May 2002. U.S. Preventive Services Task Force. Available at: http://www.ahrq.gov/clinic/uspstf/uspsdepr.htm. Accessed July 19, 2006.

      Those patients with coronary artery disease can be seen, screened, and treated best at primary care settings.

      References

        • Vieweg W.V.R.
        • Julius D.A.
        • Fernandez A.
        • et al.
        Treatment of depression in patients with coronary heart disease.
        Am J Med. 2006; 119: 567-573
        • Nease Jr, D.E.
        • Maloin J.M.
        Depression screening: a practical strategy.
        J Fam Pract. 2003; 52: 118-124
        • Gary Ruoff
        A method that dramatically improves patient adherence to depression treatment.
        J Fam Pract. 2005; 54: 846-852
      1. Screening for depression. Release date: May 2002. U.S. Preventive Services Task Force. Available at: http://www.ahrq.gov/clinic/uspstf/uspsdepr.htm. Accessed July 19, 2006.

      Linked Article

      • The Reply:
        The American Journal of MedicineVol. 120Issue 9
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          My colleagues and I appreciate Kojima’s kind remarks. We agree that the PHQ-9 questionnaire is an excellent tool to confirm a diagnosis of depression in a primary care setting. We refer readers interested in learning more about the PHQ-9 to: http://www.pfizer.com/pfizer/download/do/phq-9.pdf#search=%22patient%20health%20questionnaire%20(PHQ-9)%22 , or simply place the key words Patient Health Questionnaire (PHQ-9) into the Google search engine to be directed to the same site.
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