Exploring cardiotoxic effects of post-myocardial infarction depression

Within the first month after a heart attack (myocardial infarction (MI)), about 20% of the patients experience a major depressive episode. This is remarkably higher than in the general population, where the 12-month prevalence of major depression is approximately 5%. Compared to non-depressed M I patients, depressed MI patients have a reduced quality of life, greater functional impairments, an unhealthier lifestyle, are less adherent to lifestyle modification, cardiac aftercare, and cardiac rehabilitation, make higher health-care costs, and have a 2 to 2.5 times higher risk of getting a new cardiac event or death after the MI. For this reason, several clinical guidelines recommend that heart disease patients should be screened for depression structurally.
Chapter 2 presents a systematic review of the literature to evaluate what the empirical evidence is that screening heart disease patients for depression leads to improvements in depression and cardiac prognosis. It is concluded that there is no evidence yet that the benefits of screening outweigh the harms. The two main reasons for this conclusion are: 1) treatment for depression in heart disease patients improves depression only modestly and does not improve cardiac outcomes, and 2) no study evaluated the potential harms and benefits of screening for depression in heart disease patients.
Chapter 3 presents results from the Myocardial Infarction and Depression Intervention Trial (MIND-IT). This is a randomized controlled trial evaluating the effects of treatment for depression in depressed MI patients on the risk of new cardiac events or mortality during a mean follow-up of 5 years. Patients in the intervention group (n=209) were given feedback about their depression status and were offered several treatment options, including pharmacological and non-pharmacological treatment for depression, but they could also choose not to be treated for depression. Patients randomized to the care as usual group (n:::122) were not given feedback about their depression status, but were told that they were free to seek treatment for mood problems outside the study, which was monitored. The intervention was not effective in reducing the risk of new cardiac events and mortality in both men and women.

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