People who experience their first-ever bout of depression after having a heart attack are at greater risk for future heart problems than are patients who either don’t become clinically depressed after the medical emergency or who were depressed even before the incident, new research shows.
As a result, new depression-related screening protocols and treatment strategies may be needed to help reduce the likelihood of future heart problems in these patients, according to the research, which appears in the Dec. 5, 2006 edition of the Journal of the American College of Cardiology.
Known as the DepreMI Study, the research was conducted in the Netherlands at University Medical Centre Groningen, part of the University of Groningen. Lead researcher Peter de Jonge, PhD, said the team was seeking to determine whether all types of depression could be considered a direct cause of heart attack. What the group found was a bit surprising.
“We found that only incident (first-time) depression – no other type – was related to a poor prognosis,” said Dr. de Jonge, an assistant professor of internal medicine and psychiatry at the University of Groningen. “In other words, our findings suggest that patients who experience depression after a heart attack, but never before, are at particular risk for future incidents.
“Based on other studies, it appears that standard antidepressive treatment may not be sufficient for this category of patients,” Dr. de Jonge continued. “We feel that especially in these cases, antidepressive treatment should be integrated into cardiac after-care and made a prominent part of the rehabilitation program.”
Standard antidepressive treatment, which frequently includes medications to affect mood, may be insufficient, Dr. de Jonge explained, because incident post-heart attack depression is different than typical depression.
Patients with post-heart attack depression often have survived more severe medical emergencies than other heart attack patients, he said. As a result, these patients may be physically more exhausted and vulnerable than their peers.
“[T]his finding may explain the relatively high effectiveness of psychoeducational interventions, including stress management and relaxation, to prevent cardiac events in coronary artery disease patients,” the researchers state in their manuscript.
For the study, the researchers observed 468 patients hospitalized for heart attack for a mean follow-up period of 2.5 years. Patients were clinically evaluated for depression while in the hospital and again at three months and 12 months post-heart attack. Those with heart attack-related depression experienced more fatal and non-fatal cardiovascular emergencies than did patients who either did not become depressed or who were depressed before having a heart attack.
Based on these findings, Dr. de Jonge said, researchers need to create interventional studies in which non-standard treatments for depression are evaluated in patients with post-heart attack depression to determine which methods are most effective in protecting long-term health.
Roland von Känel, MD, a professor of medicine and head of the psychosomatic division at University Hospital Berne in Switzerland, did not participate in the study, but said it provides important information on “cardiotoxic” subtypes of depression and clues on improving care. Dr. von Känel is the first author of an editorial comment about heart attack and depression that will be published in conjunction with the new research.
“Given what we now know, I believe that screening for depression should be part of today’s clinical practice in a cardiology setting any time a patient is referred to the ICU with a heart attack,” Dr. von Känel said. “Depressed patients should be treated with counseling, referral to a psychotherapist and/or antidepressant medication – preferably an SSRI (selective serotonin reuptake inhibitor) – depending upon the severity of their depression.”
SSRI medications seek to improve mood by slowing the reuptake of the neurotransmitter serotonin in the brain; the medications have been shown to be safe and efficient in patients with heart disease. Serotonin affects emotions, mood and thought.
“In addition, improving social support, establishing a physical exercise regimen and addressing psychosocial issues, such as job situation, family conflicts and stress-causing health concerns, also may be necessary,” Dr. von Känel said. “All of these things will work together to benefit quality of life, improve adherence to cardiac treatment and reduce health care costs.”
The next steps, Dr. von Känel said, are to conduct additional research to ensure that patients receive the most effective treatments and to determine which of these treatments improve hard cardiovascular end-points, such as recurrent heart attack.
“There is no study showing to date that treatment of depression with psychotherapy improves cardiac or overall survival,” he said. “Non-randomized studies show, however, that SSRIs may benefit depressed patients after a heart attack in terms of improving cardiovascular outcome. A randomized double-blind, placebo-controlled trial with an antidepressant as well as an individually tailored psychotherapeutic intervention study are badly needed to resolve these issues.”
Amy Murphy | EurekAlert!
Millions through license revenues
27.04.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn
New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
28.04.2017 | Event News
20.04.2017 | Event News
18.04.2017 | Event News
28.04.2017 | Medical Engineering
28.04.2017 | Earth Sciences
28.04.2017 | Life Sciences