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Senior Citizen Health & Medicine
Heart Attack-Related Depression Puts Patients at
Risk for Further Cardiovascular Emergencies
Study shows need for
targeted depression screenings, treatment
December 5, 2006 - People who experience their
first-ever bout of depression after having a heart attack are at greater
risk for future heart problems than are patients who either don’t become
clinically depressed after the medical emergency or who were depressed
even before the incident, new research shows.
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As a result, new depression-related screening
protocols and treatment strategies may be needed to help reduce the
likelihood of future heart problems in these patients, according to the
research, which appears in the Dec. 5, 2006 edition of the Journal of
the American College of Cardiology.
Known as the DepreMI Study, the research was
conducted in the Netherlands at University Medical Centre Groningen,
part of the University of Groningen. Lead researcher Peter de Jonge,
PhD, said the team was seeking to determine whether all types of
depression could be considered a direct cause of heart attack. What the
group found was a bit surprising.
“We found that only incident (first-time)
depression – no other type – was related to a poor prognosis,” said Dr.
de Jonge, an assistant professor of internal medicine and psychiatry at
the University of Groningen. “In other words, our findings suggest that
patients who experience depression after a heart attack, but never
before, are at particular risk for future incidents.
“Based on other studies, it appears that standard
anti-depressive treatment may not be sufficient for this category of
patients,” Dr. de Jonge continued. “We feel that especially in these
cases, anti-depressive treatment should be integrated into cardiac
after-care and made a prominent part of the rehabilitation program.”
Standard anti-depressive treatment, which
frequently includes medications to affect mood, may be insufficient, Dr.
de Jonge explained, because incident post-heart attack depression is
different than typical depression.
Patients with post-heart attack depression often
have survived more severe medical emergencies than other heart attack
patients, he said. As a result, these patients may be physically more
exhausted and vulnerable than their peers.
“[T]his finding may explain the relatively high
effectiveness of psycho-educational interventions, including stress
management and relaxation, to prevent cardiac events in coronary artery
disease patients,” the researchers state in their manuscript.
For the study, the researchers observed 468
patients hospitalized for heart attack for a mean follow-up period of
2.5 years. Patients were clinically evaluated for depression while in
the hospital and again at three months and 12 months post-heart attack.
Those with heart attack-related depression experienced more fatal and
non-fatal cardiovascular emergencies than did patients who either did
not become depressed or who were depressed before having a heart attack.
Based on these findings, Dr. de Jonge said,
researchers need to create interventional studies in which non-standard
treatments for depression are evaluated in patients with post-heart
attack depression to determine which methods are most effective in
protecting long-term health.
Roland von Känel, MD, a professor of medicine and
head of the psychosomatic division at University Hospital Berne in
Switzerland, did not participate in the study, but said it provides
important information on “cardiotoxic” subtypes of depression and clues
on improving care. Dr. von Känel is the first author of an editorial
comment about heart attack and depression that will be published in
conjunction with the new research.
“Given what we now know, I believe that screening
for depression should be part of today’s clinical practice in a
cardiology setting any time a patient is referred to the ICU with a
heart attack,” Dr. von Känel said. “Depressed patients should be treated
with counseling, referral to a psychotherapist and/or antidepressant
medication – preferably an SSRI (selective serotonin reuptake inhibitor)
– depending upon the severity of their depression.”
SSRI medications seek to improve mood by slowing
the reuptake of the neurotransmitter serotonin in the brain; the
medications have been shown to be safe and efficient in patients with
heart disease. Serotonin affects emotions, mood and thought.
“In addition, improving social support,
establishing a physical exercise regimen and addressing psychosocial
issues, such as job situation, family conflicts and stress-causing
health concerns, also may be necessary,” Dr. von Känel said. “All of
these things will work together to benefit quality of life, improve
adherence to cardiac treatment and reduce health care costs.”
The next steps, Dr. von Känel said, are to conduct
additional research to ensure that patients receive the most effective
treatments and to determine which of these treatments improve hard
cardiovascular end-points, such as recurrent heart attack.
“There is no study showing to date that treatment
of depression with psychotherapy improves cardiac or overall survival,”
he said.
“Non-randomized studies show, however, that SSRIs
may benefit depressed patients after a heart attack in terms of
improving cardiovascular outcome. A randomized double-blind,
placebo-controlled trial with an antidepressant as well as an
individually tailored psychotherapeutic intervention study are badly
needed to resolve these issues.”
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