Heart patients should be regularly screened for depression, which increases the risk for a second heart attack, the American Heart Association said in its new guidelines, released Monday.

"Studies show that depression is about three times more common in patients following a heart attack than in the general community," said Judith Lichtman of Yale University School of Medicine, who helped write the new guidelines that appeared in the journal Circulation.

"Because there has been no routine screening for depression in heart patients, we think there is a large group of people who could benefit from appropriate treatment."

Treating depression may help to slow deterioration in health, some doctors believe. It's thought that stress hormones released during depression may reduce a person's heart rate, constrict blood vessels and lead to blockage in the arteries.

While there is no direct evidence that screening heart patients helps them live longer, depressed patients may stop taking their heart medications and are less likely to eat a healthy diet, exercise regularly or participate in rehabilitation programs, Lichtman said.

Nurses, family doctors and cardiologists may do the screening, said Erika Froelicher, who co-chaired the panel that wrote the recommendations and who is a professor of nursing at the University of California, San Francisco.

Follow how patients do over time, psychiatrist says

Screening starts with two standard questions: In the past two weeks, have you had little interest or pleasure in doing things? Have you felt down, depressed or hopeless?

Anyone showing signs of depression should be evaluated by a medical professional trained in treating depression, the panel said.

The panel's emphasis on frequent screening is key because it's important to see how patients do over time, said psychiatrist Michelle Riba, past president of the American Psychiatric Association.

Monitoring is also needed, since many patients with depression often don't follow up, said Dr. Mary Whooley, a professor of medicine at the University of California, San Francisco, who was not on the panel.

The panel listed antidepressants, psychotherapy and exercise as treatment options.

Heart problems 'made me afraid to do things,' patient says

Some of these methods did the trick for Barbara Forman, 62, of Dayton, Ohio, who believes her depression was triggered by double bypass surgery five years ago.

Forman spent her days sitting, often crying for no reason. Forman said she would be winded just walking up a sidewalk to deliver cupcakes to her grandchild's classroom.

"I'm thinking, is this the way it's going to be for the rest of my life? Since I've had a heart event, is my life over?" she said. "It also made me afraid to do things. I didn't know how a heart attack felt. I would think, 'Is this a heart attack?"'

After a few months, Forman called Mended Hearts, a support group affiliated with the American Heart Association.

Starting a walking routine, volunteering with the group and antidepressants helped improve her outlook, Forman said.

With files from the Associated Press