35 In patients hospitalized after an acute myocardial infarction (MI), those with at least mild-to-moderate

depressive symptoms were found to have lower adherence 4 click here months later to a low-fat diet, regular exercise, reducing stress, and increasing social support.36 Those with comorbid major depression or dysthymia and CHD compared with those with CHD alone Inhibitors,research,lifescience,medical also reported taking medications as prescribed less often than those without comorbid affective illnesses.36 In the Heart and Soul Study, which followed a large cohort of patients with CHD over time, twice as many depressed patients as nondepressed patients reported both forgetting Inhibitors,research,lifescience,medical to take their medications as prescribed and deciding to skip their medications.37 Several studies have also shown that patients with depression and CHD versus those with CHD alone are less likely to adhere to taking daily lowdose aspirin.38,39 Patients with comorbid depression and CHD compared with those with CHD alone have also been found to be more likely to drop out of cardiac exercise rehabilitation programs.40 Medical utilization and costs Studies have shown that patients with major depression tend to be

high utilizers of general medical services. In the Epidemiologic Catchment Area Study, Simon and colleagues showed that males with depression Inhibitors,research,lifescience,medical had a 50% greater risk and females with depression had an over threefold greater risk of being high utilizers

of general Inhibitors,research,lifescience,medical medical services (defined as >6 visits in 6 months) compared with controls without psychiatric illness.41 Katon and colleagues found that in a large primary care population, patients in the highest 10% of utilization Inhibitors,research,lifescience,medical of primary care services used 29% of primary care visits, 52% of specialty visits, 40% of hospital days, and 26% of prescriptions.42 Approximately 50% of the over 1000 high utilizers screened were psychologically distressed (based on SCL-90 depression, anxiety, or somatization scales) and two thirds old of these distressed patients met DSM-IV criteria for recurrent major depression and 40% for dysthymia based on structured psychiatric interview.42 Two thirds also had one or more chronic medical illnesses. Primary care patients with major depression have been found to have 50% to 100% greater medical costs than nondepressed controls after controlling for sociodemographic factors and severity of medical illness.43,44 Patients with comorbid depression and diabetes have been found to have 50%45 greater total medical costs, and those with comorbid depression and congestive heart failure have been found to have 30%46 greater total medical costs after controlling for sociodemographic factors and severity of medical illness.