Atlanta, GA - Depression in the first month after an MI has an adverse effect on six-month outcomes, regardless of whether it is new in onset, transiently present, or of a persistent nature, new research shows [1].

Furthermore, depressive symptoms were more consistently associated with poor outcomes than traditional measures of disease severity, such as prior MI, ST-elevation MI (STEMI), and left ventricular ejection fraction (LVEF), say Dr Susmita Parashar (Emory University, Atlanta, GA) and colleagues in their paper in the September 9, 2006 issue of the Archives of Internal Medicine.

Senior author Dr Viola Vaccarino (Emory University) told heartwire: "Doctors have this idea that, yes, patients get depressed but it's going to go away and it's not something we should worry about. But we have shown that if patients are depressed during a critical phase, this accelerates their risk, and this is a pretty novel finding."

We have shown that if patients are depressed during a critical phase, this accelerates their risk.

Parashar et al used patients enrolled in the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) to assess the prognostic importance of transient, new, or persistent depression on outcomes at six months after MI. Depressive symptoms were measured in 1873 patients during hospitalization and one month after discharge using the Patient Health Questionnaire (PHQ).

Depression was defined as transient (only at baseline), new (only at one month), or persistent (at both times). Outcomes at six months included all-cause rehospitalization or mortality and health status (angina, physical limitation, and quality of life using the Seattle Angina Questionnaire).

They found that one in five patients was depressed during the hospitalization for MI, of whom 65% had transient depression and 35% had persistent depression at one month. A further 6% of patients had new depression one month after discharge.

Transient, new, and persistent depression were all significantly associated with more rehospitalization and death, more angina, more physical limitation, and worse quality of life compared with patients who did not suffer depression. And depression was more consistently associated with poorer outcomes than traditional measures of disease severity, the authors note.

Parashar and colleagues say that, to their knowledge, this is the first study to look at in-hospital and one-month depression status after MI and subsequent outcomes.

"Even transient depression after MI is associated with worse outcomes. These findings indicate that depressive symptoms, present either during hospitalization for MI or at one month after discharge or at both times, are important, independent predictors of post-MI outcomes.

"Our results suggest the importance of early screening and identification of depressive symptoms at the time of hospitalization for MI as well as one month after discharge to potentially improve post-MI outcomes."

The researchers also found that a history of depression or antidepressant use did not change the study results. "Any depressed patients, irrespective of history of depression, are at higher risk of adverse outcomes after MI."

They hypothesize that biological mechanisms, such as immunological dysregulation, may play a role.

"It is plausible that even if depressive symptoms decrease with time in some patients with MI, the biological or behavioral effects of depression take longer to subside . . . [and] these patients remain in a trajectory of higher risk compared with patients who were never depressed, because of the initial adverse effects of depression."

The authors note that despite recent emphasis on depression screening and treatment for cardiac patients, "depression was largely undertreated in our study."

"Our data emphasize the need for future study on whether treatment of any depressive symptoms after MI, including transient depressive symptoms, can improve cardiovascular outcomes. In the meantime, depression remains an important illness, and the results of our study suggest that when [it] is found . . . considerations should be given to depression treatment."