"DON'T BE SO SURE IT'S PUMP HEAD " >Page 1,
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What to do if you or your doctor think you may have pump head
At the time of this writing, pump head has been an “official” clinical entity for only about two weeks. So frankly, it’s not yet clear that confusing depression with pump head has even been recognized as a potential problem by the medical profession.
What is clear is that the diagnosis of depression is already being missed frequently, much to the detriment of cardiac patients. And it is very clear that pump head offers a new (and most likely compelling) reason to miss the diagnosis of depression even more frequently. It seems inevitable that, sooner or later, medical researchers will recognize the problem, study it formally, and eventually sound the alarm.
But if you’re a cardiac patient who has experienced changes in your mental capacity, sluggish thinking, impaired memory, or personality changes, this is an issue you must face today. Before you accept being written off as “another unfortunate case of pump head,” you need to make certain that the presence of depression has not been missed. You can’t afford to wait for the medical profession to catch up with you on this issue. For you, it may be a matter of life or death.
Before you accept the diagnosis of pump head, you ought to insist on at least one of these two options:
1) Referral to a psychiatrist to rule out depression – even a component of depression – as an explanation of your symptoms. This is the preferable of the two options. Psychiatrists seem, as a group, to be much more familiar with the relationship between depression and serious cardiac events than are cardiologists, are far more adept at recognizing depression, and are much more experienced and comfortable treating it. Psychiatrists are adept at administering and interpreting the tests that can distinguish between depression, and the sort of cognitive deficits associated with pump head. With a formal psychiatric examination, you stand a much improved chance of receiving the appropriate diagnosis, and the appropriate therapy.
2) A trial of antidepressant therapy. It may not always be possible to sort out whether symptoms are due to depression or pump head. And even if pump head seems a sure thing, sometimes it can be impossible to tease out whether there’s a component of depression causing the patient’s symptoms. (Depression can be a prominent component of many mental disorders, such as Alzheimer’s, for instance.) Placing a patient on a trial of antiarrhythmic drug therapy may be the only way to find out for sure. {Recently, selective serotonin reuptake inhibitors (SSRIs, such as Prozac) have been shown to be as effective as the more classic tricyclic antidepressants (such as Elavil) in treating depression in cardiac patients - and they are safer.}
Summary
Depression after heart surgery or heart attacks is a common, and commonly missed problem. Because depression is treatable, and can have grave consequences in the cardiac patient if untreated, the fact that the diagnosis is often missed becomes particularly disturbing. Now, to the facts that cardiologists are often unaware of the importance of depression in their patients, and that even thinking about depression as a clinical problem seems to go against their nature, a new “excuse” for missing the diagnosis is added – the newly described condition of pump head.
Patients who are told their post-operative symptoms are due to pump head need to insist that depression be specifically considered, and specifically ruled out.
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