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Major depression (MD) is common in patients with coronary artery disease (CAD). Some of these patients have a history of prior depressive episodes, whereas others experience their first episode around the same time that their CAD is diagnosed. The purpose of this study was to determine whether there are systematic differences between these two subgroups of depressed patients. Of 39 patients with recently diagnosed CAD who met DSM-III-R criteria for MD, 17 (44%) had a prior history of MD. This subgroup had a higher proportion of females (p less than 0.003), more severe depression (p less than 0.004), were marginally younger (p = 0.08), and had slightly less severe CAD (p = 0.07) compared with those with no prior history of MD. These results support the hypothesis that there may be two distinctive subtypes of MD in patients with CAD. Additional studies are needed to determine whether these subgroups differ with respect to course, treatment, and relationship to the coronary artery disease.

To determine whether psychological factors differentiate patients with silent versus symptomatic myocardial ischemia, a battery of psychometric tests was administered to 68 patients with positive thallium stress tests. Compared with patients who became symptomatic (n = 25), patients with silent ischemia on the treadmill (n = 24) were less often aware of cardiac and other bodily sensations (p less than 0.005) and were less avoidant of harm or pain in general (p less than 0.05). They did not differ on variables associated with symptom reporting biases. To clarify the relationship between ischemia and symptom reporting, symptomatic patients were subgrouped on the basis of anginal pain latency. Psychologically, the patients with silent ischemia were most similar to patients with the longest pain latencies and most different from those who reported angina before the onset of ST depression. The psychological profile of patients with silent ischemia during exercise testing is consistent with a reduced sensitivity to pain and other bodily sensations.