HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by de Jonge, P. Articles by Ormel, J. Search for Related Content PubMed PubMed Citation Articles by de Jonge, P. Articles by Ormel, J.

Depression and anxiety after myocardial infarction

Department of Internal Medicine and Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands. Email: Peter.de.Jonge{at}med.umcg.nl

J. Ormel

Department of Psychiatry, University Medical Centre Groningen, The Netherlands

EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL

Dickens et al (2006) stress the importance of detection and treatment of anxiety and depression for quality of life after myocardial infarction and point to the mediating role of energy and fatigue.

We agree that depression following myocardial infarction predicts long-term quality of life and we recently showed that this effect persists after controlling for cardiac condition and quality of life at 3 months post-myocardial infarction (de Jonge et al, 2006). However, it is unclear whether and how detection and treatment of depression can counter these effects. In the SADHART study Glassman et al (2002) found that the effects of sertraline were modest and appeared to be restricted to depression with an onset before the infarction, but Dickens et al found that depression and anxiety which were present before myocardial infarction did not predict quality of life. In the ENRICHD trial (Berkman et al, 2003), cognitive–behavioural therapy had modest effects on depressive symptoms at 6 months post-infarction in patients with depression and social isolation, but these effects diminished over time. In the EXIT trial (Appels et al, 2005), where the focus of treatment was explicitly on vital exhaustion, only some intervention effects were observed and these were modified by the presence of a previous cardiac history.

We agree with Dickens et al that there is a need for improved detection and treatment of depression and anxiety following myocardial infarction but several questions need to be addressed. These include `can the effects of depression and anxiety be linked to specific subgroups of emotional disorders based on symptoms and/or onset?; `can interventions that were developed in general psychiatry be applied to depression post-myocardial infarction or should they be adapted?'; and `how can psychiatric interventions be integrated into regular cardiac aftercare?'

REFERENCES

Appels, A., Bar, F., van der Pol, G., et al (2005) Effects of treating exhaustion in angioplasty patients on new coronary events: results of the randomized Exhaustion Intervention Trial (EXIT). Psychosomatic Medicine, 67, 217 -223.[Abstract/Free Full Text]

Berkman, I. F., Blumenthal, I., Burg, M., et al (2003) Effects of treating depression and low-perceived social support on clinical events after myocardial infarction – the enhancing recovery in coronary heart disease patients (ENRICHD) randomized trial. JAMA, 289, 3106 -3116.[Abstract/Free Full Text]

de Jonge, P., Spijkerman, T. A., van den Brink, R. H. S., et al (2006) Depression following myocardial infarction is a risk factor for declined health-related quality of life and increased disability and cardiac complaints at 12 months. Heart, 92, 32-39.[Abstract/Free Full Text]

Dickens, C. M., McGowan, L., Percival, C., et al (2006) Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction. British Journal of Psychiatry, 189, 367 -372.[Abstract/Free Full Text]

Glassman, A. H., O'Connor, C. M., Califf, R. M., et al (2002) Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA, 288, 701 -709.[Abstract/Free Full Text]

This article has been cited by other articles:

				J.-A. Eastwood, L. Doering, J. Roper, and R. D. Hays Uncertainty and Health-Related Quality of Life 1 Year After Coronary Angiography Am. J. Crit. Care., May 1, 2008; 17(3): 232 - 242. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by de Jonge, P. Articles by Ormel, J. Search for Related Content PubMed PubMed Citation Articles by de Jonge, P. Articles by Ormel, J.