Sertraline resulted in improved depressive symptoms and no change in LVEF, ventricular ectopy, or QT interval. The study was not powered to detect a difference in cardio- vascular outcomes.238 Similarly, citalopram, a selective sero- tonin reuptake inhibitor, and mirtazapine, a dual-acting antidepressant, improved depression in postinfarction pa- tients.463,674 Thus, treatment of depression in patients with SIHD by cognitive therapy or medication is safe and contrib- utes to relief of depressive symptoms but does not have proven efficacy in reducing cardiovascular morbidity and mortality rates. Either the 2-item Patient Health Questionnaire (PHQ)-2 or the 9-item PHQ-9 can be used as a screening tool for depression701,702 (Tables 16 and 17). Patients who respond affirmatively to either item on the PHQ-2 or to item 9 on the PHQ-9 or who have a score $10 on the PHQ-9 should be referred for a more comprehensive clinical evaluation701,702 (Table 17). Patients with SIHD report high levels of psychosocial stress, and indices of stress are associated with an increased risk of cardiovascular events.245 Counseling to reduce psy- chological stress is recommended as a core component of comprehensive cardiac rehabilitation programs. Stress- management interventions use relaxation techniques and provide instruction in specific skills to reduce cognitive, behavioral, and psychological stress levels. Although stress- management programs are not of proven value in reducing the risk of cardiovascular events, they are effective in relieving anxiety and reducing depressive symptoms.461 4.4.1.8. Alcohol Consumption Class IIb 1. 