Summary
Depression and myocardial infarction (MI) are closely related. Various pathophysiological mechanisms could link depression to MI, and the different pharmacological and nonpharmacological treatment modalities that could be used have both advantages and disadvantages.
Unlike tricyclic antidepressants, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) lack arrhythmogenic effects. In addition to their beneficial effects on depression, SSRIs have positive effects on psychological factors such as anxiety and mood disturbances that are not uncommon in patients who have had an MI. Therefore, these drugs should be preferentially considered for the treatment of depression in MI patients. Studies to further determine the impact of depression on the outcome of MI, and the place of different treatment modalities, are in progress.
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References
Carney RM, Rich MW, Tevelde A. Major depressive disorders in coronary artery disease. Am J Cardiol 1987; 60: 1273–5
Schleifer SJ, Macari-Hinson MM, Coyle DA. The nature and course of depression following myocardial infarction. Arch Intern Med 1989; 149: 1785–9
de Groot PA. Consensus depression in adults. Ned Tijdschr Geneeskd 1995; 139: 1237–41
Ruberman W, Weinblatt E, Goldberg JD. Psychosocial influences on mortality after myocardial infarction. N Engl J Med 1989; 311: 552–4
Cleophas AJM, de Jong J, Niemeyer MG, et al. Changes in life-style in men under sixty years of age before and after myocardial infarction: a case-control study. Angiology 1993; 44: 761–70
Kop WJ, Appels AP, Mendes deLeon CF, et al. Vital exhaustion predicts new cardiac events after successful coronary angioplasty. Psychosom Med 1994; 56: 281–7
Honig A, Lousberg R, Wojciechowski FL, et al. Depression after first myocardial infarction: difference from ordinary depression. Ned Tijdschr Geneeskd 1997; 141: 196–9
Vasquez-Barquero JL, Padierno Acero JA, Ochoteco A, et al. Mental illness and ischemic heart disease: analysis of psychiatric morbidity. Gen Hosp Psychiatry 1985; 7: 15–20
Frasure-Smith N, Lespérance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91: 999–1005
Ahern DK, Gorkin L, Anderson JL. Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS). Am J Cardiol 1990; 66: 50–62
Frasure-Smith N. In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men. Am J Cardiol 1991; 67: 121–7
Frasure-Smith N, Lespérance T, Talajic M. Depression following myocardial infarction. JAMA 1993; 270: 1819–25
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. rev. Washington, DC: American Psychiatric Association, 1987
Ladwig KH, Röll G, Breithardt G, et al. Postinfarction depression and incomplete recovery 6 months after acute myocardial infarction. Lancet 1994; 343: 20–3
Ladwig KH, Kieser M, Konig J, et al. Affective disorders and survival after acute myocardial infarction: results from the post-infarction late potential study. Eur Heart J 1991; 12: 959–64
Travella JI, Forrester AW, Schultz SK, et al. Depression following myocardial infarction: a one year longitudinal study. Int J Psychiatry Med 1994; 24: 357–69
Cleophas TJM. Depression and survival following myocardial infarction [letter]. JAMA 1994; 271: 1081
Cleophas TJM. Post-infarction depression [letter]. Lancet 1994; 343: 680
Denollet J, Sys SU, Stroobant N, et al. Personality as independent predictor of long-term mortality in patients with coronary heart disease. Lancet 1996; 347: 417–21
Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996; 93: 1976–80
Pratt LA, Ford DE, Crum RM, et al. Depression, and the risk of myocardial infarction. Circulation 1996; 94: 3123–9
Carney RM. Depression and the heart. JAMA 1996; 276: 1123
Minneman KP. Pharmacological organization of the central nervous system. In: Brody TM, Larser J, Minneman KP, et al., editors. Human pharmacology. New York: Mosby, 1994: 293–320
Bennett JP. Drugs for affective (mood) disorders. In: Brody TM, Larser J, Minneman KP, et al., editors. Human pharmacology. New York: Mosby, 1994: 333–43
Kleiger RE, Miller JP, Bigger JT, et al. Decreased heart rate variability and its association with mortality after myocardial infarction. Am J Cardiol 1987; 59: 256–62
Carney RM, Rich M, teVelde A. The relationship between heart rate, heart rate variability and depression in patients with coronary artery disease. J Psychosom Res 1988; 32: 159–64
Dalack GW, Roose SP. Perspectives on the relationship between cardiovascular disease and affective disorder. J Clin Psychiatry 1990; 51 Suppl.: 4–9; discussion 10–1
Johnson DB, Dell Italia LJ. Cardiac hypertrophy and failure in hypertension. Curr Opin Nephrol Hypertens 1996; 5: 186–91
Ferrara N, Bunting SA. Vascular endothelial growth factor, a specific regulator of angiogenesis. Curr Opin Nephrol Hypertens 1996; 5: 35–45
Amann K, Ritz E. Cardiac structure and function in renal disease. Curr Opin Nephrol Hypertens 1996; 5: 102–6
Meltzer H, Lowy MT. The serotonin hypothesis of depression. In: Meltzer HY, editor. Psychopharmacology: the third generation of progress. New York: Raven Press, 1987: 513–26
Vanhoutte PM. Platelet-derived serotonin, the endothelium, and cardiovascular disease. J Cardiovasc Pharmacol 1991; 17Suppl. 5: 6–12
Meltzer HY, Arora RC. Platelet serotonin studies in affective disorders: evidence for a serotonergic abnormality? In: Sandier M, Coppen A, Harnett S, editors. 5-Hydroxytryptamine in psychiatry. Oxford: Oxford University Press, 1991: 50–89
Blumenthal JA, Fredrikson M, Kuhn CM, et al. Aerobic exercise reduces levels of cardiovascular and sympathoadrenal responses to mental stress in subjects without prior evidence of myocardial ischemia. Am J Cardiol 1990; 65: 93–8
Stern TA. Psychiatric management of acute myocardial infarction in the coronary care unit. Am J Cardiol 1987; 60: 59J–67J
Wardle J, Armitage J, Collins R. Effect on mood of lowering cholesterol concentration. BMJ 1996; 313: 75–8
Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ 1990; 301: 309–14
Lindberg G, Rastam L, Gulberg B, et al. Low serum cholesterol concentration and short term mortality from injuries in men and women. BMJ 1992; 305: 277–9
Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level and mortality findings for men screened in the multiple risk factor intervention trial. Arch Intern Med 1992; 152: 1490–500
Engelberg H. Low serum cholesterol and suicide. Lancet 1992; 339: 727–9
Barrett-Connor E, Palinkas LA. Low blood pressure and depression in older men: a population based study. BMJ 1994; 308: 446–9
Pyszynsky T, Grunberg J. Seifregulation, perseveration and the depression self-focusing style: a self-awareness theory of reactive depression. Psychol Bull 1987; 102: 122–38
Maier W, Lichtermann D, Minges J, et al. Personality traits in subjects at risk for unipolar major depression: a family study perspective. J Affect Disord 1992; 24: 153–63
Mendels J. The acute and long-term treatment of major depression. Int Clin Psychopharmacol 1992; 7Suppl. 2: 21–9
Hance M, Carney RM, Freedland KE, et al. Depression in patients with coronary heart disease: a twelve month follow-up. Gen Hosp Psychiatry 1995; 18: 61–5
Lespérance F, Frasure-Smith N, Talajic M. Major depression after myocardial infarction: its nature and consequences. Psychosom Med 1996; 58: 99–110
Roose SP, Glassman AH, Attia E, et al. Comparative efficacy of the specific serotonin reuptake inhibitors and tricyclics in the treatment of melancholia. Am J Psychiatry 1994; 151: 1735–9
Greene HL, Roden DM, Katz RJ. The Cardiac Arrhythmia Suppression Trial: first CAST…then CAST II. J Am Coll Cardiol 1992; 19: 804–8
Cardiac Arrhythmia Suppression Trial II (CAST II) Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 1992; 327: 227–33
Echt DS, Liebson PB, Mitchell LB. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991; 324: 781–8
Roose SP, Glassman AM. Antidepressant choice in the patient with cardiac disease: lessons from the Cardiac Arrhythmia Suppression Trial studies. J Clin Psychiatry 1994; 55Suppl. A: 83–7; discussion 88–9, 98–100
Greene LF. Fluoxetine. N Engl J Med 1994; 331: 1354–61
Walley T, Pirmohamed M, Proudlove C, et al. Interaction of metoprolol and fluoxetine. Lancet 1993; 341: 967–8
Sternbach H. Danger of antidepressant therapy after fluoxetine withdrawal. Lancet 1988; II: 850–1
Darga LL, Carroll-Michals L, Botsford SJ, et al. Fluoxetine’s effect on weight loss in obese subjects. Am J Clin Nutr 1991; 54: 321–5
Walsh BT. Fluoxetine treatment of bulimia nervosa. J Psychosom Res 1991; 35Suppl. 1: 33–40
Kaye WH, Weltzin TE, Hsu LKG, et al. An open trial of fluoxetine in patients with anorexia nervosa. J Clin Psychiatry 1991; 52: 464–71
Sindrup SH, Bjerre U, Dejgaard A, et al. The selective serotonin reuptake inhibitor citalopram relieves the symptoms of diabetic neuropathy. Clin Pharmacol Ther 1992; 52: 547–52
Stone AB, Pearlstein TB, Brown WA. Fluoxetine in the treatment of late luteal phase dysphoric disorder. J Clin Psychiatry 1991; 52: 290–3
Menkes DB, Taghavi E, Mason PA, et al. Fluoxetine treatment of severe premenstrual syndrome. BMJ 1992; 305: 346–7
Cleophas TJ, Tuinenberg E, van der Meulen J, et al. Wine consumption and other dietary variables in males under 60 before and after myocardial infarction. Angiology 1996; 47: 789–96
Pérez-Stable EJ, Miranda J, Munoz RF, et al. Depression in medical outpatients: underrecognition and misdiagnosis. Arch Intern Med 1990; 150: 1083–8
Lansberg L. Treating depression in medical conditions may improve quality of life. JAMA 1996; 276: 857–8
Gundy P. Depression and the heart. JAMA 1996; 276: 1123–4
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Cleophas, T.J.M. Depression and Myocardial Infarction. Drugs & Aging 11, 111–118 (1997). https://doi.org/10.2165/00002512-199711020-00003
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DOI: https://doi.org/10.2165/00002512-199711020-00003