Author Affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Md.
Grand Rounds at The Johns Hopkins Medical Institutions
Section Editors: David B. Hellmann, MD, D. William Schlott, MD, Stephen
D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S. Cooper,
MD, Contributing Editor, JAMA.
Depression is common among patients recovering from a myocardial infarction
(MI). Approximately 1 in 6 patients with MI experience major depression and
at least twice as many as that have significant symptoms of depression soon
after the event. Post-MI depression is an independent risk factor for increased
mortality. Although the mechanism responsible for this association has not
yet been defined, depression is clearly associated with poor compliance with
risk-reducing recommendations, with abnormalities in autonomic tone that may
make patients more susceptible to ventricular arrhythmias, and with increased
platelet activation. Coronary revascularization procedures also appear to
be used less often in those with post-MI depression than in comparable patients
without mood disorder. Ongoing research will address whether treating depression
improves prognosis. Until this question is answered, efforts should focus
on enhancing adherence to treatment regimens in this group of patients, who
are clearly at risk for noncompliance. Cardiac rehabilitation programs and
increasing levels of social support may help improve symptoms and should be
recommended to all patients. Treatment of depression itself should be individualized
until safety and efficacy are determined for antidepressant therapy in patients
who recently have had an MI.
Ziegelstein RC. Depression in Patients Recovering From a Myocardial Infarction. JAMA. 2001;286(13):1621-1627. doi:10.1001/jama.286.13.1621