The GP discusses Sheila’s depression with her and they agree on the following actions:
- referral to the Cardiac Psychology team
- referral to the Cardiac Rehabilitation team
- Sheila to be prescribed antidepressants
- Sheila to be visited at home by the heart failure nurse
Studies have shown that combination treatment of depression is more successful that treating with a single interventions, such as CBT alone or antidepressants on their own (UpToDate: Patient education: Depression treatment options for adults (Beyond the Basics))
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Cardiac Psychology team – Cognitive Behavoiural Therapy. The GP feels that Sheila may benefit from Cognitive Behavioral Thearpy (CBT) sessions. CBT is an evidence-based form of psychotherapy that aims to educate patients about their depression and to provide them with the knowledge and skills to self-manage. Royal College of Psychiatrists: Cognitive Behavioural Therapy
Cardiac Rehabilitation team – Exercise. Cardiac rehabilitation involves components of physical activity, health education, advice on cardiovascular risk reduction, and stress management. If you would like to review your knowledge and understanding of Cardiac rehabilitation, please go to Cardiac Rehabilitation module. As well helping with the physical symptoms of Sheila’s heart failure, exercise is moderately effective in reducing the symptoms of depression.
Pharmacotherapy – Antidepressants. The presence of heart failure complicates selection of antidepressant medication for Sheila. However, selective serotonin reuptake inhibitors (SSRIs) tend to be the medication of choice, as they are generally well tolerated and safe for use with cardiac patients. SSRIs have also been shown ot have a meaningful effect on major depression.
Page last reviewed: 25 Sep 2020
