Does Treating Post–Myocardial Infarction Depression Reduce Medical Mortality?

Depression and cardiovascular disease are 2 of the most common public health problems in the Western world¹ and are strongly comorbid.² The increased mortality associated with major depressive disorder (MDD) after myocardial infarction (MI) is equal to or greater than any medical predictor of risk.³ Even though the evidence is strong, physicians rarely think of depression as a medical risk factor and are unlikely to examine for it in patients after MI, whereas screening for heart failure, arrhythmia, or diabetes is a standard of care. Evidence linking depression and cardiac death comes from epidemiologic studies that screen all MI or unstable angina cases, not just patients seeking treatment, and, therefore, includes many mild cases. Even mildly elevated depression symptoms increase risk of cardiac death, although the risk increases with depression severity.⁴ Physicians who recognize depressed mood after MI frequently dismiss it as an understandable and temporary response to a stressful event. If they do treat post-MI depression, typically they treat only the most symptomatic cases. Even if physicians recognize that mortality is increased with less severe depression, there is no definitive evidence that treating depression reduces the risk of dying. In fact, little has been established about how or even whether to treat MDD in patients after MI.