title: Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction.
abstract: BACKGROUND
  Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression.
  
  
  OBJECTIVE
  We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression.
  
  
  METHODS
  Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatment-resistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months.
  
  
  RESULTS
  During follow-up of 4037 patients with major depressive disorder who had had a myocardial infarction, 6.9% of those with insufficiently treated depression, 2.4% of those with treated depression and 5.0% of those with treatment-resistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95% CI 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95% CI 1.05-2.79) times more likely to die.
  
  
  CONCLUSIONS
  All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.
authors.affiliation: St. Louis Veterans Affairs Medical Center, Research Service (151-JC), 501 North Grand Boulevard, St Louis, MO 63103, USA. scherrej@psychiatry.wustl.edu
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.forename: Timothy
authors.initials: T
authors.lastname: Chrusciel
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Garfield
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Freedland
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carney
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Bucholz
authors.forename: Richard
authors.initials: R
authors.lastname: Owen
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Lustman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000401:mortality*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000401:mortality*; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D016016:Proportional Hazards Models; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D000928:Antidepressive Agents