Depression following a heart infarct and increased risk of death
Honig, A.
Nederlands Tijdschrift Voor Geneeskunde 144(27): 1307-1310
2000
ISSN/ISBN: 0028-2162 PMID: 10918909 Document Number: 526047
Depression is an important risk factor for cardiac mortality, especially in the first 18 months after a myocardial infarction. Listlessness and a hostile mood are the specific features of the depression following myocardial infarction, rather than depressed mood. Also, depressed post infarction patients are more often re-admitted for cardiac reasons and their work resumption is delayed. There are indications that depression and myocardial infarction have an aetiological relationship via the behavior and emotions that are a risk factor for the development of both disorders. Depression and myocardial infarction are both stress-related disorders. A pathological stress reaction is seen in both conditions and triggers immune activation, enhanced blood cortisol levels, disturbance of serotonin metabolism and increased sympathetic activation. Early detection of post-infarction depression and treatment with a selective serotonin reuptake inhibitor (SSRI) is advised. SSRIs have been shown to be efficacious and safe in this patient population. Tricyclic antidepressants (TCAs) are relatively contra-indicated due to their cardiac side effects. As yet, no therapeutic effect of antidepressants, in the sense of decreased cardiac mortality or a decrease in fatal rhythm disorders, has been demonstrated.