Clinical Practice Guideline

Depression Following Acute Coronary Syndrome


Screening and Treatment of Depression Following Acute Coronary Syndrome

 (Developed by the AAFP, March 2019)

The guideline, Screening and Treatment of Depression Following Acute Coronary Syndrome, was developed by the American Academy of Family Physicians and approved by the Board of Directors in March 2019.  The guideline was published in the American Family Physician on June 14, 2019.

Key Recommendations

  • A standardized depression screening tool (e.g. BDI-II, HADS, GDS, PHQ) should be used to screen for depression in patients who have recently experienced an acute coronary syndrome (ACS) event.
  • In patients who screen positive for depression, further assessment should be performed to confirm the diagnosis of depression
  • Antidepressant medication, preferably SSRIs/SNRIs, and/or CBT should be prescribed to improve symptoms of depression in patients who have a history of ACS and have been diagnosed with depression.  Tricyclic antidepressants (TCAs) have multiple adverse events, including potential cardiotoxicity and should not be used in patients with heart disease.

See the full recommendation for further details.


These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.