Navigation Links
Clinical depression raises risk of death for heart attack patients years after attack
Date:3/3/2008

March 3, 2008 -- Depressed heart attack patients have a higher risk for sudden death in the months following a heart attack. Now a team led by researchers from Washington University School of Medicine in St. Louis has found that the risk continues for many years.

"There's a two- to four-fold increase in a person's risk of dying following a heart attack if they also happen to be depressed," says Robert. M. Carney, Ph.D., lead author of the new study and professor of psychiatry at Washington University. "Previously we thought the impact of depression was strongest for the first three to six months following a heart attack and then gradually dropped off within a couple of years. Instead, we found that the effect lasts for at least five years."

Carney, with colleagues from Duke University Medical Center, Harvard University, Yale University, the National Heart, Lung and Blood Institute (NIH) and the Mayo Clinic, followed more than 750 heart attack patients for five years. The findings will appear in an upcoming issue of the Journal of Affective Disorders and are currently available online.

Patients followed in the study had participated in the NIH-funded project Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD). A little less than half were diagnosed with depression.

In the five years following a heart attack, 106 patients died. Of those, 62 had been diagnosed with depression, while 44 had not. In gauging the effects of depression, the investigators also considered other risks including age, smoking, hypertension, gender and diabetes.

Some of those factors, like younger age and female gender, lower mortality risk. Smoking and diabetes tend to raise the risk of dying. Carney says his team used statistical methods to evaluate the ways in which the various factors influenced mortality risk. Then they removed the influence of all other factors from the risk equation in order to consider the statistical impact of depression itself.

"We found that after adjusting for those risk factors, depression continues to play a statistically significant role," he says.

One possible explanation for depression's lingering influence on mortality is its recurring nature. Because the disorder can come and go over many years, it also may continue to increase the risk of death for many years.

"People typically are depressed for a while, then they'll either get better with treatment or it may subside on its own," Carney says. "But depression can always recur, and we think that because it is a recurring problem, whatever depression is doing to mortality risk after a heart attack, it continues doing for quite a long time."

Past studies have differed over how much depression affects survival following a heart attack. But Carney believes these new findings are more reliable because all of the patients in this study were personally interviewed to determine their depression status, whereas other studies have relied on self-reporting.

"In our experience, self-reporting tends to overestimate the risk because it's often not possible to evaluate the causes of various symptoms on self-report questionnaires," he explains. "Say somebody reports having sleeping problems that would go into the depression column as a symptom. But it's possible they are sleeping poorly because of a bad back or because they have to get up and go to the bathroom frequently during the night. During an interview, we can determine whether an individual symptom is related to depression or can be explained in some other way."

Carney's team also found that any clinically relevant depression increases the risk of death in heart attack patients. The risk was elevated both for patients with major depression, which requires the presence of five or more symptoms, and minor depression, which requires between two and four symptoms for diagnosis. Major depression was associated with higher risk, but minor depression also was associated with a significant increase in mortality risk.

Even with mounting evidence of a link between depression and death in heart attack patients, only about 25 to 30 percent of these patients receive antidepressant drugs or other depression treatments.

That doesn't surprise Carney. His team reported in 2003 in the Journal of the American Medical Association that providing treatment for depression seemed to have little effect on whether patients survived or had a second heart attack. This could be because the treatments don't work for all patients, Carney says, and he suggests if current depression treatments could be improved, survival rates might increase, too.

To this end, his team is studying whether omega-3 fatty acids the fatty acids found in fish oil might improve antidepressant therapies in heart patients. They're giving an antidepressant drug and a special formulation of omega-3 to some heart patients and comparing them to depressed heart patients who receive an antidepressant but no omega-3.

"We have not been satisfied with the effectiveness of standard antidepressants at alleviating depression in this population of patients," Carney says. "We're studying omega-3, because there's preliminary evidence that the fatty acids also might make depression therapies more effective, both in treating depression and in improving heart health."


'/>"/>

Contact: Jim Dryden
jdryden@wustl.edu
314-286-0110
Washington University School of Medicine
Source:Eurekalert

Related medicine news :

1. IAVI and VaxDesign partner to develop a clinical trial in a test tube for AIDS vaccines
2. Skin Friendly Releases Clinically Proven Hypoallergenic Anti-Bacterial Barrier Lotion
3. New study of targeted therapies for breast cancer -- model for global clinical trials
4. IDC X-Series DR system selected for use in leading edge RSA clinical trial application
5. Communicating Clinical Trial Data: Timing Remains Key Challenge for Marketing Teams
6. HealthpointCapital, LLC Appoints Stephen H. Hochschuler, M.D. as Clinical Advisor
7. Daniel Magilavy, M.D. Joins Rigel as Vice President of Clinical Research
8. Pharsight to Present at eClinical Forum
9. PRA International to Open Expanded Clinical Pharmacology Center
10. Elsevier enhances clinical decision making with suite of Clinical Decision Support solutions
11. Hyperion Therapeutics Announces Enrollment of First Patient in Phase 2 Clinical Trial in Patients With Hepatic Encephalopathy
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... ... June 24, 2016 , ... Marcy was in a crisis. Her son James, eight, was out ... family verbally and physically. , “When something upset him, he couldn’t control his emotions,” remembers ... would throw rocks at my other children and say he was going to kill them. ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has extensive experience with all areas ... , AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is a revolutionary adjunct ...
(Date:6/24/2016)... ... 2016 , ... People across the U.S. are sharpening their pencils and honing ... contest in which patients and their families pay tribute to a genetic counselor by ... Society of Genetic Counselors (NSGC) Annual Education Conference (AEC) this September. , In ...
(Date:6/24/2016)... ... June 24, 2016 , ... Puradigm® & Innovative Solutions ... initiated cultivation and processing operations at its production facility, and opened its first ... is the manufacturer of a complete system of proactive air and surface purification ...
(Date:6/24/2016)... ... 2016 , ... Venture Construction Group (VCG) sponsors Luke’s Wings ... at the Woodmont Country Club at 1201 Rockville Pike, Rockville, Maryland, 20852. The ... members that have been wounded in battle and their families. Venture Construction Group is ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 2016 Research and Markets has announced ... Analysis 2016 - Forecast to 2022" report to their ... contains up to date financial data derived from varied research ... trends with potential impact on the market during the next ... which comprises of sub markets, regional and country level analysis. ...
(Date:6/23/2016)... and INDIANAPOLIS , June 23, ... a Lilly Diabetes Tomorrow,s Leaders Scholarship is any indication, ... winners, announced today online at www.diabetesscholars.org by ... 1 diabetes stand in the way of academic and ... the Foundation,s scholarship program since 2012, and continues to ...
(Date:6/23/2016)... Research and Markets has announced the addition ... States, China, Japan, Brazil, United Kingdom, Germany, France, Italy, ... Surgical Procedure Volumes: Global ... surgical procedure volume data in a geographic context. The ... of growth drivers and inhibitors, including world population growth, ...
Breaking Medicine Technology: