TREATMENT OF DEPRESSION IN POST MI PATIENTS

Treatment of Depression in Post MI Patients

Acknowledgement

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

Abstract

Depression in the patient who has recently suffered a myocardial infarction is common, with an estimated prevalence of 20%. However, despite this high prevalence, depression in the post -myocardia infarction patient is poorly diagnosed and treated. In addition, depression in these patients has been associated with increased cardiac morbidity and mortality as well as increased disability and health care cost. The pathophysiology relating these two conditions remains unclear but may be related to autonomic dysfunction and enhanced risk of arrhythmias. Few well-designed trials have evaluated treatment options for these patients, although several large trials are underway. Of the antidepressant medications available, they all have potential interactions with the cardiac system. However, the serotonin selective reuptake inhibitors seem to be emerging as the best first line treatment option for these patients.

Table of contents

Acknowledgementii

Abstractiii

Chapter 1: Introduction1

Research back ground1

Chapter 2: Literature Review3

Frequency of Depression in Post -MI Patients3

Association between Depression and MI4

Impact of Depression on Patients Who Suffer an MI4

Pathophysiology Linking Depression and Cardiac Disease6

Treatment Trials7

Choosing an Antidepressant9

Tricyclics9

Monoamine Oxidase Inhibitors (MAOIs)10

Trazodone10

Selective Serotonin Reuptake Inhibitors (SSRIs)11

Bupropion11

Venlafaxine12

Nefazodone12

Chapter 3: Methodology14

Research Design14

Keywords14

Chapter 4: Discussion15

Possible Relationships Between Depression and MI16

Clinical profile and prevalence17

Risk Factors of Post-MI Denression19

Biological Risk Factors20

Psychological Risk Factors21

Social Risk Factors21

Treatment ofpost-MI depression22

Pharmacological Treatment22

Efficacy22

Safety23

Effect on Cardiac Prognosis23

Rehabilitation, Psychological Intervention, and Psychotherapy24

Psychological factors25

Chapter 5: Conclusion27

Limitation of the study28

Abbreviations:30

References31

Chapter 1: Introduction

Myocardial infarction (MI) is a major cause of mortality and morbidity in the western world. As MI is a life threatening event it is hardly surprising that it often causes distress and impairment of quality of life for patients and their relatives, especially partners. For a substantial minority of families such consequences are profound. 

Major depression and cardiovascular disease represent two of the most prevalent disorders. As the population of the elderly continues to grow, one can expect to see more people who suffer from both of these disorders. This paper will examine the frequency, association, and impact of depression in the post-myocardial (MI) patient. This will include a brief discussion of treatment trials and possible pathophysiologic mechanisms relating to depression and cardiac disease (AHERN 1990 59-62). The cardiovascular complications of antidepressant medications will also be reviewed. It is hoped that this information will help guide the clinician in treating these complicated patients.

Research back ground

About 20% of post myocardial infarction (MI) patients experience a major depressive episode and an equal percentage experience a minor depressive episode in the first year post MI . Recent data suggest that minor depressive disorder is not evanescent, and may occur independent of, or in the course of, a major depressive disorder (ALBERT 1998 23-28). Both major and minor depressive disorders post MI are associated with an increased risk of all-cause mortality, cardiac mortality, and new cardiovascular events . Also, post-MI depressive disorder predicts slow recovery and poor quality of life (5-9). Treatment refractoriness of major and minor depressive disorders is ...