Treating Depression in MI Patients: Interview with Susmita Parashar, MD, MPH, MS

When did this study take place? Why was it important to study depression in this population of patients? Is depression becoming more prevalent in heart failure patients? This study took place between January 2003 and June 2004. It is important to study depression in MI patients because depression is independently associated with morbidity, mortality and worse functional status after MI. Depression predicts mortality with strength of association at least equivalent to left ventricular dysfunction and prior MI. Of all the patients studied, how many reported experiencing depression? The overall prevalence of moderate to severe depressive symptoms was 20.6% (n = 387) during the MI hospitalization and 13.1% (n = 246) at one-month post-discharge. Describe the three classifications of depression: transient, new, persistent. Which of the categories (if any) had the largest number of patients? We classified patients into three categories according to presence of depressive symptoms at MI hospitalization and at one month after discharge. Patients were classified as having transient depression if depressive symptoms were present only at MI hospitalization; new depression if depressive symptoms were present only at one-month post-MI; and persistent depression if these symptoms were present at both times. The largest number of patients was in the transient depression category (13.5%). What were some of the symptoms that depressed patients exhibited? What were some of the problems associated with depression? Some of symptoms depressed patients exhibited were little pleasure in doing things, feeling down, depressed or hopeless, feeling tired, poor appetite, difficulty falling or staying asleep or trouble concentrating. Patients with depressive symptoms had higher rates of rehospitalization or mortality and more angina, more physical limitation, and worse quality of life after MI compared with non-depressed patients. What treatments do you think patients should undergo to treat depression? Is more education also needed to help both physicians and patients recognize depression? Treatment choice for depression depends on the evaluation by the primary care physician or mental health specialist. There are a variety of antidepressant medications and psychotherapies that can be used to treat depression. In addition, more education is needed for both physicians and patients to reiterate the importance of early screening and identification of depressive symptoms at the time of hospitalization for MI as well as at one month after discharge. How long should patients be monitored for depression after experiencing a cardiac event? Patients should be monitored for depression at every visit to their health care provider. Are women at a greater risk of developing depressive symptoms after a cardiac event? Women with MI are much more vulnerable to depression than men, with prevalence rates that are 1.5-2.0 times higher than male counterparts. In our recent article in the Archives of Internal Medicine, we found that a level of moderate or severe depression was found in 41% of women < 60 years, 21% of men < 60 years, 21% of women greater than or equal to 60 years and 16% of men greater than or equal to 60 years. Describe the PREMIER Registry. Is the PREMIER Registry ongoing? The Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery (PREMIER) was developed to document the prevalence, determinants and consequences of post-MI angina. Nineteen U.S. sites participated in this registry. Consenting patients participated in a baseline interview during hospitalization, and their clinical data were abstracted from the medical records. After discharge, follow-up interviews were conducted via telephone or if needed by mail, by a national follow-up center at 1-, 6- and 12-months after MI. Baseline enrollment for PREMIER started in January 2003 and was completed in June 2004. Is there anything else you'd like to add? Not all patients become depressed after having a MI. Depression should not be considered a normal reaction after MI. Clinicians and patients should be aware that depression is an important risk factor for adverse outcomes after MI. Since depression and CHD are associated with substantial health and economic burden, it is important to screen for depression after MI.