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About 1 in 5 patients become depressed after a heart attack, but doctors don’t always pick up on the symptoms because they can be difficult to distinguish from the physical effects of heart disease, such as fatigue and sedentary behavior. (Read more about heart disease and depression in the WSJ.)

Moreover, cardiologists are taught to focus on the heart and may not be attuned to other symptoms, according to Roy Ziegelstein, vice chairman of the department of medicine at Johns Hopkins Bayview Medical Center and head of the depression and cardiovascular research group. It’s one of the hazards of the specialization of medicine, he told us.

He shares his own experience with recognizing the importance of depression in treating patients with heart disease: About 15 years ago, during his first or second month as a faculty member at Hopkins, he was responsible for the coronary care unit. He saw a man, in his 60s at the time, who had experienced a major heart attack for which he had needed to be on a ventilator. The man left the hospital doing fine, says Ziegelstein.

A few weeks later, the patient came back by himself for a checkup with “absolutely no symptoms” of heart disease, said Ziegelstein. Later on, he got a call from the patient’s wife, who asked how her husband was doing. “I said, ‘he’s doing great,’ ” says Ziegelstein. “I could tell from the silence on the other end of the line she didn’t agree.”

The wife described how her husband was now in his room all the time and had no interaction with any of his friends anymore. Ziegelstein realized that “I had missed a really important diagnosis,” his patient’s depression. That happened, says Ziegelstein, because in the course of his training, he had begun paying “gradual attention to just one area [the heart] at the expense of another.”

Health Blog Question of the Day: Doctors, do you feel that the specialization of medicine has affected your patient care?

Excerpt from:
How One Doc Discovered the Connection Between Heart Disease and Depression