Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: rationale and outline of the Myocardial INfarction and Depression-Intervention Trial (MIND-IT).
BACKGROUND
Patients with a depressive disorder after myocardial infarction (MI) have a significantly increased risk of major cardiac events. The Myocardial INfarction and Depression-Intervention Trial (MIND-IT) investigates whether antidepressive treatment can improve the cardiac prognosis for these patients. The rationale and outline of the study are described.


METHODS
In this multicenter randomized clinical trial, 2140 patients admitted for MI are screened for depressive symptoms with a questionnaire 0, 3, 6, 9, and 12 months after MI. Patients with symptoms undergo a standardized psychiatric interview. Those with a post-MI depressive episode are randomized to intervention (ie, antidepressive treatment; n = 190) or care-as-usual (CAU; n = 130). In the intervention arm, the research diagnosis is to be confirmed by a psychiatrist. First-choice treatment consists of placebo-controlled treatment with mirtazapine. In case of refusal or nonresponse, alternative open treatment with citalopram is offered. In the CAU arm, the patient is not informed about the research diagnosis. Psychiatric treatment outside the study is recorded, but no treatment is offered. Both arms are followed for end points (cardiac death or hospital admission for MI, unstable angina, heart failure, or ventricular tachyarrhythmia) during an average period of 27 months. Analysis is on an intention-to-treat basis.


CONCLUSIONS
The MIND-IT study will show whether treatment of post-MI depression can improve cardiac prognosis.
Department of Psychiatry, Graduate School of Behavioral and Cognitive Neurosciences, University Hospital Groningen, Groningen, The Netherlands. r.h.s.van.den.brink@med.rug.nl
Rob H S
RH
van den Brink
Joost P
JP
van Melle
Adriaan
A
Honig
Aart H
AH
Schene
Harry J G M
HJ
Crijns
Frank P G
FP
Lambert
Johan
J
Ormel
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000078785:Mirtazapine; D009203:Myocardial Infarction / Q000150:complications*; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*
D000928:Antidepressive Agents; D015283:Citalopram; D008803:Mianserin; D000078785:Mirtazapine