Depression and myocardial infarction: Relationship between heart and mind

1. There is a relationship between depression and Myocardial Infarction (MI ) as higher levels of depression and severe depression (major vs minor) are associated with higher morbidity and mortality due to cardiac events, whic h are mainly caused by arrhythmia. 2. Second, severity of MI is not or even inversely related to development o f depression. Depression post-MI goes often unrecognized as only 10% of dep ressed MI patients are diagnosed as such. This underestimation of depressio n is attributed to its atypical profile, tendency of physicians to interpre t depressive symptoms as a transient and 'natural' reaction to a life-threa tening event, and the scarce knowledge of risk factors associated with deve lopment of post-MI depression. 3. During the first 18 months following MI major depression occurs in 15-30 % of patients. 4. Depression should be assessed in an early stage as depression has the hi ghest prevalence in hospital and in the first 6 months post-MI. Risk factor s for developing post-MI depression include complications during hospitaliz ation, prescription of benzodiazepines during hospitalisation, previous his tory of depression, and not being able to stop smoking. 5. Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be first choic e treatment in post-MI depression. As yet there is no information on the ef ficacy and safety of Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs) .