Exploring cardiotoxic effects of post-myocardial infarction depression

PhD ceremony: Ms. M. Zuidersma, 16.15 uur, Aula Academiegebouw, Broerstraat 5, Groningen

Dissertation: Exploring cardiotoxic effects of post-myocardial infarction depression

Promotor(s): prof. P. de Jonge, prof. J. Ormel

Faculty: Medical Sciences

After a heart attack, about 20% of patients experience a depressive episode. Compared to non-depressed patients, those with depression are at a 2 to 2.5 times increased risk of subsequent cardiac events or mortality. Unfortunately, treatment for depression does not appear to reduce this risk. This thesis reports on how specific aspects of the depressive episode contribute to this increased risk. For this purpose, heart attack patients were interviewed to evaluate the presence of depression, and questionnaires were used to assess the presence and severity of depressive symptoms and vital exhaustion. The patients were followed for several years to evaluate the occurrence of subsequent cardiac events and mortality. The increased risk of subsequent cardiac events and mortality was not related to the diagnosis of depression, but rather to treatment-resistant depression, somatic/affective depressive symptoms, vital exhaustion and an increase in the number of depressive symptoms soon after the heart attack. Additionally, up to 50% of the increased risk associated with depressive symptoms can be explained by a more severe heart disease in this group. Two reasons are discussed why depression treatment does not improve cardiac prognosis. First, depression treatment may not improve cardiac prognosis, because it is not effective in patients who have the highest risk of new cardiac events. Second, depression treatment may not target factors that underlie the association between depression and cardiac prognosis, such as the severity of the heart disease.