Depression and Acute Myocardial Infarction

Monte Malach, MD; Pascal James Imperato, MD, MPH & TM


Prev Cardiol. 2004;7(2) 

In This Article

Abstract and Introduction

A number of studies have demonstrated a relationship between depression and low perceived social support and increased cardiac morbidity and mortality in patients with coronary heart disease. There is also evidence that depression increases the risk of acute myocardial infarction and morbidity and mortality following it. This review examines those studies that have investigated these relationships as well as those that have attempted to explain them on the basis of various pathophysiologic mechanisms. Among the latter are studies that have shown that selective serotonin reuptake inhibitors are beneficial in the treatment of depression and that they appear to reverse the enhanced platelet activity observed in depressed patients with acute myocardial infarction. Depression increases hospital length of stay, procedures, readmission rates, and the cost of medical care. Much remains to be elucidated concerning the roles of depression and low perceived social support in predisposing to acute myocardial infarction and to increased morbidity and mortality following it. However, sufficient scientific evidence exists for physicians to make efforts to diagnose and treat depression to reduce the concurrent risk of acute myocardial infarction and morbidity and mortality following it.

Recent studies have identified depression and depressive disorders as risk factors for acute myocardial infarction (AMI) and as being associated with increased post-AMI morbidity and subsequent mortality.[1,2] Yet, the influences of depression on AMI have not been widely appreciated in clinical practice.[3,4] Known coronary artery disease (CAD), hypertension, diabetes mellitus (the equivalent of CAD), hyperlipidemia, family history, smoking, obesity, and cocaine use are all recognized risk factors for AMI; however, there is growing evidence that depression and depressive disorders are important risk factors. Most current studies of depression define it according to the criteria established by the American Psychiatric Association. These criteria are listed in the association's Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR and five or more of the following nine symptoms must be present for diagnosis:[5] depressed mood; diminished interest, especially in pleasure (anhedonia); weight loss or gain >5% with increase/decrease in appetite; insomnia or hypersomnia; psychomotor agitation or depression; fatigue; feeling of worthlessness or guilt; diminished ability to concentrate; and recurrent thoughts of death or suicide.