AFP Clinical Answers

Depression After ACS, Amenorrhea, Physical Activity, Heart Failure, Erythema Multiforme


Am Fam Physician. 2020 Jan 15;101(2):75.

What is the AAFP recommendation for screening and treating depression after an acute coronary syndrome (ACS) event?

Patients are at high risk of depression after ACS events and should be routinely screened for depression. Standard treatment with antidepressant medications (selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors) and/or cognitive behavior therapy is effective, with the combination of both having the strongest evidence of benefit.

How should functional hypothalamic amenorrhea be treated?

Functional hypothalamic amenorrhea is a disorder of chronic anovulation caused by hypothalamic-pituitary axis suppression from body weight loss, excessive exercise, or stress. In patients with functional hypothalamic amenorrhea, treatment should correct the underlying cause to restore ovulatory function through behavior change, nutritional repletion (e.g., caloric intake, vitamin D), stress reduction, and weight gain. Although functional hypothalamic amenorrhea may cause bone density loss, combined oral contraceptives do not improve bone density and should not be used solely for this purpose.

What are the recommendations for and key benefits of physical activity?

It is recommended that adults perform 150 to 300 minutes of moderate physical activity each week. However, any increase in activity has been demonstrated to be beneficial for health, especially for those who do not meet goals. Exercise reduces symptoms of depression and anxiety while improving sleep quality. For older adults, increasing physical activity can help them maintain independence by reducing cognitive decline and falls.

Should physicians use a combination of an ACE inhibitor and an ARB in patients with heart failure?

Compared with monotherapy, the combination of an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin receptor blocker



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