Depression After Heart Attack

Depression is 3 times more common in patients after a heart attack than in the general population, with 15% to 20% of heart attack victims qualifying for a diagnosis of major depressive disorder, and a far greater proportion experiencing increased levels of depressive symptoms. This comes as no surprise, given that major life stressors are known to contribute to the development of depression, and a heart attack certainly qualifies as such a stressor. Depression after a heart attack is bad not only because of the accompanying emotional distress and suffering; it also increases one’s risk of having another heart attack or dying over the ensuing months and years. Listed in Table 1 are several characteristics that have been found in depressed persons that could account for a poorer prognosis after a heart attack.View this table:Table 1. Mechanisms Contributing to Poor Prognosis After Heart AttackOn the basis of this extensive evidence that depression not only causes misery, but is also associated with a poorer prognosis after a heart attack, an American Heart Association Science Advisory panel recently recommended that patients who have had a heart attack be screened for depressive symptoms to identify those “who may require further assessment and treatment.”1 As shown in Table 2, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders , Fourth E dition (DSM-IV) specifies depressed mood (feeling sad, “down,” unhappy, dissatisfied) and a marked reduction in interest or …