Treating the Aching Heart

I suspect I am like many family physicians, often left to wonder why many of my depressed patients and my patients with heart disease do not seem to respond well to standard treatments. I cannot explain why these patients do not get better or even how they got so sick in the first place. Dr. Wulsin's book illuminates some of the answers to these questions. Treating the Aching Heart is a fascinating and extremely helpful book for both patients and clinicians. The author tackles 2 enormous subjects, depression and coronary artery disease, and explores the pathologic links between the 2 as well as the influences they have on each other. Dr. Wulsin presents his material logically, chapter building upon chapter. He makes a potent argument that Americans pay a high price for ignoring the connection between these 2 common diseases that cause a tremendous burden of suffering for many in the United States. He clearly explains how depression negatively affects the major risk factors for heart disease. He takes us through the current understanding of the neurobiology of depression and then elucidates its links with chronic inflammation and sympathetic nervous system overactivity in the pathophysiology of heart disease. Dr. Wulsin pulls all of this together in several elegant charts and diagrams that he intends to be used as practical tools for the assessment and treatment of depression and heart disease. He closes the book with a challenge to integrate the care of depression and heart disease in our fragmented health care system and so begin to ease the suffering of our patients. This book has multiple features that will be helpful to both patients and the physicians who care for them. The Clinical Tips are practical suggestions that will help patients take a more active role in their treatment. I think the tips may be especially helpful in giving patients practical advice about depression. The appendices contain a number of figures, charts, and Web site links that provide practical tools for both patients and physicians. In particular, I found the Patient Health Questionnaire Depression checklist to be a tool I can easily put to use in my practice. There are several features I particularly enjoyed about the book. Dr. Wulsin's use of clinical vignettes reminded me of my own patients and grounded the book in day to day clinical practice. The figures at the end of chapters 7 and 8 are not just an excellent visual summary of his main thoughts but are also novel clinical tools I am anxious to apply directly to the care of my patients. I expect the visual summary of a patient's risk profile for coronary artery disease will make it easier to provide more comprehensive care. Finally, I appreciated his challenge to join the process of overhauling our health care system and work to integrate the care of these 2 common and debilitating diseases. I think most of us have been frustrated many times by the separation of mental health care and care for physical problems into separate fiefdoms that rarely communicate with each other. If we are frustrated, how must our patients feel? While Dr. Wulsin points out there is much yet to be learned about the interconnections between the 2 diseases, I am greatly encouraged that he has written Treating the Aching Heart. This is a useful, thoughtful book worthy of wide reading in the medical community. I suspect it will lead the way to more efforts that connect the neurobiology of the brain to the pathophysiology of other common disease processes. Jonathan D. McKrell, M.D. Saint Vincent Family Medicine, Erie, Pennslyvania