Post-Myocardial Infarction Depression. Evidence Report/Technology Assessment Number 123

摘要

Major depression is common among patients recovering from a myocardial infarction (MI). Additionally, clinically significant depressive symptoms are present in other patients whose symptom severity or duration does not meet established criteria for a diagnosis of major depression. Over the last decade, increasing evidence suggest that in addition to its effect on quality of life post-MI depression also deserves attention because of a reported relation to increased morbidity and mortality. Researchers at the Johns Hopkins University-Evidence-based Practice Center conducted a systematic review of evidence on post-MI depression and found that post-MI depression is associated with a significantly increased risk of subsequent death, of cardiac re-admission and poor quality of life during the first year. Strong evidence exists to indicate that both psychosocial interventions and selective serotonin reuptake inhibitors are effective in improving depression in MI survivors, but there is no evidence that either decreases mortality or cardiac events. Although it is not clear whether the frequency of prescription of cardiac medications or use of cardiac procedures is different based on the presence of depression, there is relatively strong evidence that those with post-MI depression have lower adherence to prescribed medications and secondary prevention measures than those with depression.