Post Myocardial Infarction Depression and Subsequent Cardiac Events

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Post Myocardial Infarction Depression and
Subsequent Cardiac Events

• By Mitchell Kee

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Background

• 20 of patients post myocardial infarction (MI)
  develop depression
• 2-2.5 fold increase
• risk of mortality
• (all causes)
• Risk of cardiac mortality is also increased

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Previous Studies

• Inconclusive
• Some suggest that treatment for depression can
• Protect the heart
• Have no effect
• Be Cardiotoxic
• CBT had no improved prognosis as compared to
  normal care

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This Study

• Prior studies
• Little improvement of prognosis with
  antidepressants
• No effect on the depression in these studies
• This study Does effective treatment for
  depression affect cardiovascular prognosis

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What do we want to know?

• Will Responders after 24 weeks have lower risk of
  cardiovascular events?
• Is the increased risk in nonresponders an effect
  of refractory depression on the heart?

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Method

• Recruit patients admitted with MI
• Exclude those with
• MI not reason for hospitalisation
• Dis. likely to affect short term survival
• Previous history of psychiatric illness
• In another clinical trial

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Procedure

• Selected patients screened for depression at 3
  months
• Treatment vs. normal care
• No information for normal care patients

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Subjects

• In total
• 90 - double-blind mirtazapine/placebo for 8 weeks
• 100 received usual care

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Course of Action

• Hamilton Depression scale
• If unresponsive switch to citalopram (open)
• After 24 weeks - classed as responders and
  nonresponders
• Responders 50 drop in HAM-D or HAM-D lt9

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Results

• 45 - mirtazapine (M).
• 15 nonresponders (NR), given Citalopram (C)
• 45 - placebo (P)
• 25 NR, given C
• Overall 70 - drugs (either C or M)
• 100 - no drugs
• After 24 weeks
• 40 - R
• 60 - NR

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Results

• Cardiac events (24wk-18mth)
• 25 NR
• 7 R
• 11 U
• Depression after 18 months
• 10 R
• 33.3 U
• 60 NR

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What does this mean?

• Responders vs. untreated similar results
• Clearly presence of treatment not main factor
• Nonresponders
• Higher chance of recurrence of depression
• Higher chance of cardiac event

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So?

• Subtype of post MI depression
• Increases chance of further event
• Refractory to normal treatment
• Persistent depression is responsible for most
  events

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Conclusion

• Persistent depression
• Increases reactivity of platelets
• Increases ANS activity
• Increased immune system reactions
• These increase chance of cardiac event

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• Thank you for your attention

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• source nonresponse to treatment for depression
  following mzocardial infarction association with
  subsquent cardiac events
• Amerian Journal of Psychiatry september 2007