Depression Ratings and Antidepressant Use among Outpatient Heart Failure Patients: Implications for the Screening and Treatment of Depression

Objective: To investigate the characteristics of antidepressant use among heart failure (HF) outpatients. Methods: Self-reported data on antidepressant use, Beck Depression Inventory (BDI) ratings, and demographics, as well as HF diagnosis severity, was collected from 218 New York Heart Association (NYHA) Classes I–IV HF outpatients (mean age 57.29 years). Results: The overall prevalence of depressive symptoms (BDI ⩾ 10) was 43.1% (n = 94); 23.4% had a prior diagnosis of depression. Thirty-three percent of patients were taking antidepressants but, despite this treatment, 64% still showed at least mild-moderate depressive symptoms (BDI ⩾ 10) compared to 34% of patients not currently receiving antidepressants (p = 0.05). When asked if their mood had improved as a result of antidepressant therapy, 45% reported responses ranging from “halfway back to normal” to no improvement at all; BDI scores were related to self-reports of how well antidepressant therapy affected patient's mood (p < .01). Among patients receiving antidepressants (primarily SSRIs), 26% did not have a formal depression diagnosis prior to receiving antidepressants, and 39.1% reported never having had a dose adjustment in antidepressant medication. Similar numbers of patients were prescribed antidepressants by primary care physicians as mental health providers, while much fewer cardiologists prescribed antidepressants. Conclusions: Findings provide insight into practice and provider patterns related to antidepressant use in HF. HF patients treated with antidepressants still show high rates of depressed mood, and follow-up and monitoring of effectiveness of antidepressant therapy needs attention. Effective treatment of depression could support improved clinical outcomes and better quality of life for HF patients.