The American Heart Association, in recently released guidelines concerning heart patients, recommended that heart patients should be regularly screened for signs of depression. According to the recommendations published in the journal Circulation, depression is three times as common in survivors of heart attacks and those hospitalized with heart problems as compared to the general population.

The situation is worrisome as depressed patients stand twice the risk of a second heart attack and these patients are more likely to stop making positive changes in their lifestyle which could help reduce the risk of a subsequent heart attack.

Erika Froelicher, professor of nursing at the University of California, San Francisco said, "I think we could reduce considerable suffering and improve outcomes. I know we can do more by screening." The study authors said that half of the heart doctors treated depression in their patients and not all the patients who are diagnosed with depression symptoms get treatment.

Doctors say that depression screening should be conducted as routine like blood pressure and cholesterol tests, and doctors should be able to gauge a patient’s mental state just by asking a few routine questions. Seeing signs of depression, the patient should be referred to a clinical social worker or psychologist and followed by therapy, exercise, antidepressants or cardiac rehabilitation.

Froelicher, who was co-chair of the panel that wrote the recommendations said everyone from a cardiologist to a primary care doctor can and should be involved in the diagnosis of depression. Heart patients should be screened by first asking two basic questions: In the past two weeks, have you had little interest or pleasure in doing things? Have you felt down, depressed or hopeless?

If the answer is ‘yes’ to one or both questions, the patient should then be given a questionnaire to determine if the patient is depressed and the severity of the problem. Once depression is established the patient should then be referred to a professional qualified to treat depression.

Some physicians are qualified to treat it — others may be more comfortable referring the problem to a qualified mental health professional," Froelicher said.

The stress on frequent screening was important said psychiatrist Michelle Riba, past president of the American Psychiatric Association, which has endorsed the heart association's recommendations. "What you want to see in a particular patient is how they do over time," said Riba.

Dr. Mary Whooley, a professor of medicine at the University of California, San Francisco, who was not on the panel said, "A lot of patients with depression don't follow up on it."