[Depression following a heart infarct and increased risk of death].
Depression is an important risk factor for cardiac mortality, especially in the first 18 months after a myocardial infarction. Listlessness and a hostile mood are the specific features of the depression following myocardial infarction, rather than depressed mood. Also, depressed post infarction patients are more often re-admitted for cardiac reasons and their work resumption is delayed. There are indications that depression and myocardial infarction have an aetiological relationship via the behavior and emotions that are a risk factor for the development of both disorders. Depression and myocardial infarction are both stress-related disorders. A pathological stress reaction is seen in both conditions and triggers immune activation, enhanced blood cortisol levels, disturbance of serotonin metabolism and increased sympathetic activation. Early detection of post-infarction depression and treatment with a selective serotonin reuptake inhibitor (SSRI) is advised. SSRIs have been shown to be efficacious and safe in this patient population. Tricyclic antidepressants (TCAs) are relatively contra-indicated due to their cardiac side effects. As yet, no therapeutic effect of antidepressants, in the sense of decreased cardiac mortality or a decrease in fatal rhythm disorders, has been demonstrated.
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Academisch Ziekenhuis, afd. Psychiatrie & Neuropsychologie, Maastricht.
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D000075202:Contraindications; D003863:Depression / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D009203:Myocardial Infarction / Q000523:psychology*; D012307:Risk Factors; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013315:Stress, Psychological / Q000209:etiology*
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors