Depression Dangerous After Heart Attack

Depression (search) can cast a dark cloud over the heart as well as the mind. New research shows that depressed heart attack survivors are twice as likely to die or have more heart problems in the two years following a heart attack.

It’s not unusual for people to become depressed after a heart attack (search). About 18 percent of heart attack survivors have major depression, says Joost van Melle, MD, of University Hospital Groningen in the Netherlands.

Recently, van Melle and colleagues reviewed 22 studies on depression after heart attack. The data included more than 6,300 heart attack survivors. Death, heart disease, and depression were tracked for up to two years after participants’ heart attacks.

Depressed heart attack patients were more than twice as likely to die of any cause and 2.5 times as likely to die of heart disease compared with those without depression.

Depression might trigger heart problems. But it might be the other way around, with heart disease spurring depression. Other health factors could also be important. Either way, all signs suggest that safeguarding mental health is important for heart attack survivors.

"It must be taken into account that sicker patients may have an increased risk to become depressed and subsequently have a worse cardiovascular prognosis. In other words, it is possible that the observed risk is in reality caused by poor cardiac function," van Melle says in a news release.

Depression’s Long Shadow

The findings of van Melle and colleagues are echoed in a second study organized by Jürgen Barth, PhD, of Germany’s University of Freiburg. Barth and van Melle’s reports appeared in the November/December issue of Psychosomatic Medicine.

Barth and colleagues reviewed 20 studies from 1980-2003. Their conclusion: Depression more than doubled the risk of death in the two years following a heart attack, but it took six months after the heart attack before depression increased the risk of death.

It didn’t matter if depression was reported by the patients themselves or screened for by experts, say Barth and van Melle.

The latest findings are in line with previous research. Depressed heart patients can also have other health woes, too.

Depressed heart patients are nearly twice as likely as non-depressed heart patients to feel at least mildly burdened by their heart symptoms, be in fair or poor overall health, have mild physical limitations, and have mildly diminished quality of life. Those findings were based on 1,000 heart patients. The Journal of the American Medical Association published the study in 2003.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: van Melle, J. Psychosomatic Medicine, November/December 2004; vol 66: pp 814-822. Barth, J. Psychosomatic Medicine, November/December 2004; vol 66: pp 799-801. WebMD Medical News: “Depression Affects Heart Patient Health.” News release, Health Behavior News Service of the Center for the Advancement for Health.