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Depression and Myocardial Infarction

Implications for Medical Prognosis and Options for Treatment

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  • Disease Management
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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

  1. Carney RM, Rich MW, Tevelde A. Major depressive disorders in coronary artery disease. Am J Cardiol 1987; 60: 1273–5

    Article  PubMed  CAS  Google Scholar 

  2. Schleifer SJ, Macari-Hinson MM, Coyle DA. The nature and course of depression following myocardial infarction. Arch Intern Med 1989; 149: 1785–9

    Article  PubMed  CAS  Google Scholar 

  3. de Groot PA. Consensus depression in adults. Ned Tijdschr Geneeskd 1995; 139: 1237–41

    PubMed  Google Scholar 

  4. Ruberman W, Weinblatt E, Goldberg JD. Psychosocial influences on mortality after myocardial infarction. N Engl J Med 1989; 311: 552–4

    Article  Google Scholar 

  5. 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

    Article  PubMed  CAS  Google Scholar 

  6. 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

    PubMed  CAS  Google Scholar 

  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

    PubMed  CAS  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. Frasure-Smith N, Lespérance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91: 999–1005

    Article  PubMed  CAS  Google Scholar 

  10. 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

    Article  Google Scholar 

  11. 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

    Article  PubMed  CAS  Google Scholar 

  12. Frasure-Smith N, Lespérance T, Talajic M. Depression following myocardial infarction. JAMA 1993; 270: 1819–25

    Article  PubMed  CAS  Google Scholar 

  13. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. rev. Washington, DC: American Psychiatric Association, 1987

    Google Scholar 

  14. Ladwig KH, Röll G, Breithardt G, et al. Postinfarction depression and incomplete recovery 6 months after acute myocardial infarction. Lancet 1994; 343: 20–3

    Article  PubMed  CAS  Google Scholar 

  15. 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

    PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. Cleophas TJM. Depression and survival following myocardial infarction [letter]. JAMA 1994; 271: 1081

    Article  PubMed  CAS  Google Scholar 

  18. Cleophas TJM. Post-infarction depression [letter]. Lancet 1994; 343: 680

    Article  PubMed  CAS  Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996; 93: 1976–80

    Article  PubMed  CAS  Google Scholar 

  21. Pratt LA, Ford DE, Crum RM, et al. Depression, and the risk of myocardial infarction. Circulation 1996; 94: 3123–9

    Article  PubMed  CAS  Google Scholar 

  22. Carney RM. Depression and the heart. JAMA 1996; 276: 1123

    Google Scholar 

  23. 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

    Google Scholar 

  24. 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

    Google Scholar 

  25. 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

    Article  PubMed  CAS  Google Scholar 

  26. 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

    Article  PubMed  CAS  Google Scholar 

  27. 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

    PubMed  Google Scholar 

  28. Johnson DB, Dell Italia LJ. Cardiac hypertrophy and failure in hypertension. Curr Opin Nephrol Hypertens 1996; 5: 186–91

    Article  PubMed  CAS  Google Scholar 

  29. Ferrara N, Bunting SA. Vascular endothelial growth factor, a specific regulator of angiogenesis. Curr Opin Nephrol Hypertens 1996; 5: 35–45

    Article  PubMed  CAS  Google Scholar 

  30. Amann K, Ritz E. Cardiac structure and function in renal disease. Curr Opin Nephrol Hypertens 1996; 5: 102–6

    Article  PubMed  CAS  Google Scholar 

  31. 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

    Google Scholar 

  32. Vanhoutte PM. Platelet-derived serotonin, the endothelium, and cardiovascular disease. J Cardiovasc Pharmacol 1991; 17Suppl. 5: 6–12

    Google Scholar 

  33. 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

    Chapter  Google Scholar 

  34. 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

    Article  PubMed  CAS  Google Scholar 

  35. Stern TA. Psychiatric management of acute myocardial infarction in the coronary care unit. Am J Cardiol 1987; 60: 59J–67J

    Article  PubMed  CAS  Google Scholar 

  36. Wardle J, Armitage J, Collins R. Effect on mood of lowering cholesterol concentration. BMJ 1996; 313: 75–8

    Article  PubMed  CAS  Google Scholar 

  37. Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ 1990; 301: 309–14

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

  39. 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

    Article  PubMed  CAS  Google Scholar 

  40. Engelberg H. Low serum cholesterol and suicide. Lancet 1992; 339: 727–9

    Article  PubMed  CAS  Google Scholar 

  41. Barrett-Connor E, Palinkas LA. Low blood pressure and depression in older men: a population based study. BMJ 1994; 308: 446–9

    Article  PubMed  CAS  Google Scholar 

  42. 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

    Article  Google Scholar 

  43. 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

    Article  PubMed  CAS  Google Scholar 

  44. Mendels J. The acute and long-term treatment of major depression. Int Clin Psychopharmacol 1992; 7Suppl. 2: 21–9

    Article  PubMed  Google Scholar 

  45. 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

    Article  Google Scholar 

  46. Lespérance F, Frasure-Smith N, Talajic M. Major depression after myocardial infarction: its nature and consequences. Psychosom Med 1996; 58: 99–110

    PubMed  Google Scholar 

  47. 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

    PubMed  CAS  Google Scholar 

  48. Greene HL, Roden DM, Katz RJ. The Cardiac Arrhythmia Suppression Trial: first CAST…then CAST II. J Am Coll Cardiol 1992; 19: 804–8

    Article  Google Scholar 

  49. 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

    Article  Google Scholar 

  50. 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

    Article  PubMed  CAS  Google Scholar 

  51. 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

    PubMed  Google Scholar 

  52. Greene LF. Fluoxetine. N Engl J Med 1994; 331: 1354–61

    Article  Google Scholar 

  53. Walley T, Pirmohamed M, Proudlove C, et al. Interaction of metoprolol and fluoxetine. Lancet 1993; 341: 967–8

    Article  PubMed  CAS  Google Scholar 

  54. Sternbach H. Danger of antidepressant therapy after fluoxetine withdrawal. Lancet 1988; II: 850–1

    Article  Google Scholar 

  55. 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

    PubMed  CAS  Google Scholar 

  56. Walsh BT. Fluoxetine treatment of bulimia nervosa. J Psychosom Res 1991; 35Suppl. 1: 33–40

    Article  PubMed  Google Scholar 

  57. 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

    PubMed  CAS  Google Scholar 

  58. 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

    Article  PubMed  CAS  Google Scholar 

  59. Stone AB, Pearlstein TB, Brown WA. Fluoxetine in the treatment of late luteal phase dysphoric disorder. J Clin Psychiatry 1991; 52: 290–3

    PubMed  CAS  Google Scholar 

  60. Menkes DB, Taghavi E, Mason PA, et al. Fluoxetine treatment of severe premenstrual syndrome. BMJ 1992; 305: 346–7

    Article  PubMed  CAS  Google Scholar 

  61. 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

    Article  PubMed  CAS  Google Scholar 

  62. Pérez-Stable EJ, Miranda J, Munoz RF, et al. Depression in medical outpatients: underrecognition and misdiagnosis. Arch Intern Med 1990; 150: 1083–8

    Article  PubMed  Google Scholar 

  63. Lansberg L. Treating depression in medical conditions may improve quality of life. JAMA 1996; 276: 857–8

    Article  Google Scholar 

  64. Gundy P. Depression and the heart. JAMA 1996; 276: 1123–4

    Google Scholar 

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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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