Editor's Correspondence |

Recognition and Clinical Management of Depression in Congestive Heart Failure

Ernest H. Friedman, MD
Arch Intern Med. 2002;163(3):362. doi:.
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Recognition and clinical management of depression in patients with congestive heart failure1 may be facilitated by monitoring the rate of speech hesitation pauses (SHPs) of 1 second or more, which correlated with (1) immobility in the face of stress, (2) the state of the circulatory system (angina and/or hypertension), and (3) a 6-fold incidence of clinical coronary heart disease in 2 groups of men with normal coronary structure observed prospectively for 10 years (P<.05). Neurobiological features are demonstrated by (1) reports that SHPs are behavioral correlates of mood; (2) the correlation of rate and variability in duration of SHPs with the left hemisphere and right hemisphere, respectively; (3) profound effects on angina of consciously focusing attention on breathing and intervening pauses; and (4) the association of reduction in blood pressure with longer, less recurrent SHPs (about 2 seconds). Additionally, the microvascular response to the onset of neural activity is delayed consistently about 3 seconds and is linked to increased coherence of electroencephalographic gamma-band activity (30-50 Hz or broader, centered on 40 Hz) associated with the execution of more complex tasks.24

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