A 58-Year-Old Man Comes to the Office Due to Low

A 58-year-old man comes to the office due to low motivation and loss of interest.  He says, "I love my family and work is okay, but I'm just not able to enjoy anything anymore.  On weekends, I sit on the couch all day and avoid my friends.  I prefer to be alone."  The patient has a history of hypertension, hypercholesterolemia, and coronary heart disease.  Family history is significant for a father with cardiovascular disease and mother with osteoporosis and breast cancer.  The patient's uncle died following a myocardial infarction at age 62.  After a full evaluation, the patient is diagnosed with major depressive disorder.  Treatment options, including psychotherapy and antidepressants, are discussed, but the patient is reluctant to consider either treatment.  He says, "With my schedule I have no time for therapy and I don't like to talk about these things.  I am also concerned about the effects of medication on my heart.  I don't want to die at such a young age like my uncle did."  Which of the following is the most accurate statement when counseling the patient?

A) Given your cardiac condition, we should start by using a lower dose of antidepressant medication.
B) I recommend reconsidering psychotherapy due to potential interactions between antidepressant and cardiac medications.
C) I recommend starting antidepressant treatment, which has been shown to prevent heart attacks.
D) I understand your priorities, so let's monitor your depression and focus on your cardiac condition.
E) Untreated depression is associated with increased morbidity and mortality from cardiovascular disease.