Depression often untreated in black heart patients

NEW YORK , 30 oct 2008– African Americans with heart disease are as likely to suffer from depression as their white counterparts, but they are less likely to be on medication for it, a new study suggests.
The study of 864 adults with coronary heart disease found that 35 percent of African Americans and 27 percent of whites had symptoms of depression. Yet black patients were less than half as likely to be on an antidepressant medication.
The findings are important, the researchers say, because depression in people with heart disease has been linked to a two- to four-fold higher risk of complications.
Studies have found that depressed heart disease patients have higher risks of a heart attack or stroke, and may die earlier than those without depression.
"Undertreatment of depression is a serious clinical issue," Dr. James Blumenthal, one of researchers on the current study, said in a statement.
These latest findings suggest that black heart patients, in particular, need better diagnosis and treatment of depression, according to Blumenthal and his colleagues at Duke University Medical Center in Durham, North Carolina.
The study included 727 white patients and 137 black patients seen at Duke for coronary heart disease. All completed a standard questionnaire used to screen for depression.
Blumenthal's team found that depression was similarly common among black and white patients, and the severity of their symptoms was comparable as well.
However, while 21 of depressed white patients were on an antidepressant, only 12 percent of black patients were.
The difference was greatest among men; 43 percent of moderately to severely depressed white men were taking an antidepressant, versus 22 percent of their black counterparts.
The researchers are not sure why the racial disparity exists. They lacked information on the study patients' health insurance, so it's not possible to tell whether differences in coverage are a factor. Nor do they know whether doctors were less likely to prescribe to black patients, or whether African Americans were less likely to want an antidepressant.
Blumenthal pointed out that therapies other than antidepressants may be helpful for heart disease patients' depression. He is currently conducting a study comparing aerobic exercise with drugs in treating depression.
"We clearly need to do a better job of recognizing and treating depression, especially in heart patients," Blumenthal said. "We need treatments that work, treatments that are acceptable to patients, and treatments that are actually incorporated into medical practice."
SOURCE: American Heart Journal, October 2008.