Myocardial Infarction and Depression

Abstract

Background: Depressive symptoms are common among post myocardial infarction (MI) patients and may cause negative impacts on cardiac prognosis. 35 to 45% of MI patients report depression. Depression is an independent risk factor for MI and post MI mortality and decreased quality of life in post MI patients. The link between depression and MI is bidirectional. Behavioral and biological mechanisms were proposed as the plausible mechanisms between post-MI depression and increased risk of mortality. Biological mechanisms include arrhythmias, hemostasis, immunological pathway, neuroendocrinological mechanism and increased thrombosis. The combination of these mechanisms is likely to involve in increasing the risk of mortality. Epidemiological studies have shown the link between depression and increased risk for development of cardiovascular disease, MI and cardiac mortality. The adverse impact of depression on prognosis of heart disease is preventable with the right treatment. A number of therapeutic approaches have been advocated for post-MI depression, including cardiac rehabilitation, social support, cognitive behavior therapy, and antidepressants. Because of adverse effects, it is recommended to avoid prescription of tricyclics for treating post MI depression. If SSRIs are prescribed shortly after MI the important side effects caused by them will be low.

Keywords

• Myocardial infarction
• Depression
• Mortality
• Treatment of depression
• Behavioral mechanisms
• Biological mechanisms