DEPRESSION, PSYCHOTROPIC MEDICATION, AND RISK OF MYOCARDIAL-INFARCTION - PROSPECTIVE DATA FROM THE BALTIMORE ECA FOLLOW-UP

Background There is suggestive evidence that depression increases risk of myocardial infarction (Mr), but there are no prospective studies i n which the measure of depression corresponds to clinical criteria. Th is study examines prospectively whether a major depressive episode inc reases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship. Methods and Results The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catc hment Area Study, a survey of psychiatric disorders in the general pop ulation. A history of major depressive episode, dysphoria (2 weeks of sadness), and psychotropic medication use were assessed in 1981, and s elf-reported MI was assessed in 1994. Sixty-four MIs were reported amo ng 1551 respondents free of heart trouble in 1981. Compared with respo ndents with no history of dysphoria, the odds ratio for MI associated with a history of dysphoria was 2.07 (95% CI, 1.16 to 3.71), and the o dds ratio associated with a history of major depressive episode was 4. 54 (95% CI, 1.65 to 12.44), independent of coronary risk factors. In m ultivariate models, use of barbiturates, meprobamates, phenothiazines, and lithium was associated with an increased risk of MI, whereas use of tricyclic antidepressants and benzodiazepines was not. Among indivi duals with no history of dysphoria, only lithium use was significantly associated with MI. Conclusions These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI. The association between psychotropic medication use and MI is probably a r eflection of the primary relationship between depression and MI.