Newly Depressed Heart-Attack Patients at Cardiac Risk

Their odds of second attack are higher than for those with prior history of depression, study finds

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By Ed Edelson
HealthDay Reporter

MONDAY, Nov. 27, 2006 (HealthDay News) -- Depression after a heart attack is a warning sign of future cardiac problems -- but only if it's the first time the patient has been clinically depressed, a Dutch study finds.

The study helps clarify recent findings that have linked depression with a poorer cardiac prognosis after a heart attack, said Johan Ormel, an epidemiologist and a member of the research team at the University Medical Center Groningen.

"There has been quite a lot of talk about the effect of post-myocardial infarction [heart attack] depression on prognosis," Ormel said. "There have been two or three studies which tried to treat post-myocardial infarction depression, hoping that recovery would have a long-term positive impact. This randomized trial failed to demonstrate this."

The new study findings are published in the Dec. 5 issue of the Journal of the American College of Cardiology.

The researchers followed 468 patients hospitalized for heart attack for an average of 2.5 years. They evaluated the patients for depression while in the hospital and again at three and 12 months after the heart attack.

As expected, the incidence of subsequent cardiac events was higher in people diagnosed with depression. But the increase was concentrated among the patients who were not depressed before their heart attacks. The incidence of adverse effects for these patients was 65 percent higher than for patients without depression.

In contrast, the rate of heart events was only 12 percent higher for depressed patients who were also depressed before their heart attacks.

"Based on other studies, it appears that standard antidepressive treatments may not be sufficient" for patients suffering from first-time depression after heart attack, lead researcher Peter de Jonge, assistant professor of internal medicine and psychiatry, said in a statement. "We feel that especially in these cases, antidepressive treatment should be integrated into cardiac after-care and made a prominent part of the rehabilitation program."

The study indicates 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. Roland von Kanel, professor of medicine and head of the psychosomatic division at University Hospital Berne, Switzerland, said in a statement.

Depressed heart attack patients should be treated with counseling, referral to a psychotherapist and/or antidepressant medications, von Kanel recommended.

But it's still too early to draw definite conclusions from the study, Ormel said. It was an observational study, which means that it lacked the controls of prospective, randomized trials, the gold standard of medical research.

The study results also go against the conventional wisdom, added Dr. Daniel E. Ford, professor of medicine and psychiatry at the Johns Hopkins Medical Institutions.

"In general, we have thought that when depression is present before a myocardial infarction, that is the group we should start treating early and that represents a higher risk," he said.

For patients whose depression appears after a heart attack, the belief has been "don't jump on any depression treatment, because it may resolve by itself," Ford said. "This kind of changes the approach to it, so we need to keep on doing more research."

More information

There's more on depression at the U.S. National Institute of Mental Health.

SOURCES: Johan Ormel, Ph.D, epidemiologist, University Medical Center Groningen, Switzerland; Daniel E. Ford, M.D., professor of medicine and psychiatry, Johns Hopkins Medical Institutions, Baltimore; Dec. 5, 2006, Journal of the American College of Cardiology

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