Post-myocardial infarction depression: consequences and treatment. (In Consultation)

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Date: Jan. 2003
From: The Journal of Critical Illness(Vol. 18, Issue 1)
Publisher: CMP Medica, LLC
Document Type: Article
Length: 1,065 words

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How does depression influence the prognosis of patients recovering from a myocardial infarction (MI)? What should the focus of interventions be?

At least 1 in 6 patients has major depression after an MI, (1) and more than 3 of 4 are still depressed 3 months later. (2) There is increasing evidence that depression significantly increases mortality (3-7) as early as 4 months after an MI. (6) Although exactly how mood disturbances adversely affect post-MI outcomes is unknown, depression has been associated with increased platelet reactivity; (8) decreased heart rate variability, (9) decreased use of coronary revascularization procedures, (10) and a decreased likelihood that patients will follow recommendations intended to reduce their cardiac risk. (11)

Several approaches can reduce symptoms of depression after an MI. Cardiac rehabilitation improves both symptoms of depression and exercise capacity. (12,13) However, psychologically distressed patients have an increased dropout rate from cardiac rehabilitation programs, (14,15) so involvement should be advocated strongly and potential barriers to participation eliminated, if possible. Major depression typically requires therapy with antidepressant drugs, and the selective serotonin reuptake inhibitors (SSRIs) have proved safe and effective in patients recovering from an MI. (16,17) These agents may be preferable to the tricyclic antidepressants in patients with post-MI depression; the latter have been associated with adverse cardiac side effects in patients with ischemic heart disease. (18,19)

Results of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study and the Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) showed that different interventions (cognitive therapy and the SSRI sertraline, respectively) improved post-MI depression, but neither study showed the effect of treatment on mortality. (20,21)...

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Gale Document Number: GALE|A97113782