Practice Guidelines

Depression After ACS Events: AAFP Releases Updated Guidelines


Key Points for Practice

• Patients are at high risk of depression after acute coronary syndrome events and should be routinely screened for depression.

• Standard depression treatment with antidepressant medications and/or cognitive behavior therapy is effective after acute coronary syndrome events, with the combination of both having the strongest evidence of benefit.

• Women have higher rates of depression after acute coronary syndrome events than men.

From the AFP Editors

More than 25 million U.S. adults have heart disease, with more than 1 million adults hospitalized with acute coronary syndrome (ACS) events each year. After ACS events, patients are at increased risk of mental health disorders, including major depressive disorder, which affects one in five ACS survivors.

The American Academy of Family Physicians (AAFP) has released a guideline focusing on depression in adults within three months of an ACS event (unstable angina or myocardial infarction). The guideline is based on a systematic review of randomized controlled trials and observational studies and covers screening and treatment. It updates a 2009 guideline on depression after myocardial infarction.


Physicians should screen patients who have had a recent ACS event for depression using a standardized screening tool (weak recommendation, low-quality evidence). Further evaluation should be performed to confirm the diagnosis of depression (good practice point).

The AAFP recommends depression screening in the general adult population and has found adequate evidence that use of depression screening tools in patients with recent ACS events is comparable with that in the general population. Depression after ACS events can be accurately diagnosed using screening instruments such as the Beck Depression Inventory II, Geriatric Depression Scale, Hospital and Anxiety Depression Scale, and Patient Health Questionnaire. The Beck Depression Inventory II has the most data supporting its use following

Author disclosure: No relevant financial affiliations.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

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Apr 1, 2020

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