Depression is common among patients recovering from a myocardial infarction (MI). Approximately 1 in 6 patients with MI experience major depression and at least twice as many as that have significant symptoms of depression soon after the event. Post-MI depression is an independent risk factor for increased mortality. Although the mechanism responsible for this association has not yet been defined, depression is clearly associated with poor compliance with risk-reducing recommendations, with abnormalities in autonomic tone that may make patients more susceptible to ventricular arrhythmias, and with increased platelet activation. Coronary revascularization procedures also appear to be used less often in those with post-MI depression than in comparable patients without mood disorder. Ongoing research will address whether treating depression improves prognosis. Until this question is answered, efforts should focus on enhancing adherence to treatment regimens in this group of patients, who are clearly at risk for noncompliance. Cardiac rehabilitation programs and increasing levels of social support may help improve symptoms and should be recommended to all patients. Treatment of depression itself should be individualized until safety and efficacy are determined for antidepressant therapy in patients who recently have had an MI.
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