From the Guidelines
Myocardial infarction (heart attack) significantly increases the risk of developing depression, with up to three times more common in patients with acute myocardial infarction (AMI) compared to the general population, as reported in a 2022 study published in Circulation 1. The relationship between myocardial infarction and depression is bidirectional, with depression also increasing the risk of cardiovascular events and mortality in patients with heart disease. Key points to consider include:
- Depression typically develops within the first few weeks after a heart attack but can occur months later.
- Screening for depression should be conducted during follow-up visits using standardized tools like the PHQ-9.
- Treatment options include selective serotonin reuptake inhibitors (SSRIs) such as sertraline or escitalopram, which have favorable cardiovascular safety profiles.
- Psychotherapy, particularly cognitive behavioral therapy, is also effective either alone or in combination with medication. The underlying mechanisms connecting these conditions include inflammatory processes, autonomic nervous system dysfunction, and behavioral factors like medication non-adherence and lifestyle choices, as discussed in a 2014 study published in Circulation 1. Early identification and treatment of depression in heart attack survivors is crucial as it improves both quality of life and cardiac outcomes, with a significant risk-adjusted association between depression and increased cardiac mortality reported in several studies, including a 2014 systematic review and recommendations from the American Heart Association 1.
From the FDA Drug Label
Patients with a recent history of myocardial infarction or unstable heart disease were excluded from clinical studies during the product’s premarket testing However, the electrocardiograms of 774 patients who received sertraline in double-blind trials were evaluated and the data indicate that sertraline is not associated with the development of significant ECG abnormalities Sertraline administered in a flexible dose range of 50 to 200 mg/day (mean dose of 89 mg/day) was evaluated in a post-marketing, placebo-controlled trial of 372 randomized subjects with a DSM-IV diagnosis of major depressive disorder and recent history of myocardial infarction or unstable angina requiring hospitalization
The incidence of depression in patients with myocardial infarction (heart attack) is not directly stated in the provided drug label. However, it is mentioned that 372 patients with a recent history of myocardial infarction or unstable angina were evaluated in a post-marketing trial, and all of them had a DSM-IV diagnosis of major depressive disorder. This suggests that the patients in this trial had a 100% incidence of depression, but this cannot be generalized to all patients with myocardial infarction, as this was a specific study population 2.
From the Research
Incidence of Depression in Patients with Myocardial Infarction
The incidence of depression in patients with myocardial infarction (MI) is a significant concern, with various studies indicating a high prevalence of depression in these patients.
- According to a study published in the European journal of preventive cardiology 3, approximately 27.3% of MI patients were screened for depression, with a higher screening rate among patients with a history of mental illness, anxiety, or depression.
- A study published in the Danish medical journal 4 found that about one-fifth of patients had depression three months after MI, according to the Hospital Anxiety and Depression Scale (HADS).
- Another study published in the Archives of general psychiatry 5 found that depression after MI is associated with higher morbidity and mortality, highlighting the importance of screening and treatment for depression in these patients.
Risk Factors and Prognosis
Depression after MI is associated with adverse outcomes, including increased risk of new cardiovascular events or death 4.
- The risk of death or recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors (SSRIs) compared to those who did not use SSRIs 5.
- Physical activity and antidepressants may modify the adverse prognosis in patients with post-MI depression, but larger studies are needed to clarify the impact of these potential modifiers 4.
- MI increases the risk of suicide, and depression following MI impairs the overall prognosis 4.
Screening and Treatment
Routine depression screening and subsequent treatment in post-MI patients may lead to improved cardiac outcomes 6.
- However, screening for depression is not a standard of post-MI care, despite recommendations from the American Heart Association (AHA) 6.
- A study published in Current problems in cardiology 6 found that post-MI patients diagnosed with depression were more likely to experience a subsequent cardiovascular-related hospitalization within 2 years of MI than those not diagnosed with depression.