Achieving the Balance-A Systematic Review on Treating Depression Post Myocardial Infarction

Abstract

Introduction:Post myocardial infarction (MI) depression is a known complication and its treatment is a challenging task in a diseased heart. A variety of psychotherapies and pharmacotherapies are available. Pharmacotherapies such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) are routinely used in depressive patients without heart disease. In MI patients, these drugs can cause fatal arrhythmias, bleeding and sudden cardiac death. However, psychotherapies and behavioral treatments like Cognitive Behavioral Therapy (CBT) and Exercise Therapy (ET) do not have such serious side effects. This systematic review aims to look for the most suitable anti-depressant therapy in post-MI depression, which also has a cardio-protective role. Methods: This Systematic Review was conducted according to Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Literature search from PubMed, Medline, PubMed Central and Google Scholar was carried out. Medical Subject Heading (MeSH) technique was used with keywords like 'Myocardial Infarction', 'Heart Attack', 'Depression', 'Serotonin Levels' and 'Major Depression'. Boolean variables like 'AND' and 'OR' were used. The inclusion criteria was literature in English language published between 2018 to 2022, with studies restricted to human studies only with patient age between 45-64. Results: After applying inclusion criteria to initially searched 319780 articles, we were left with 1841 results. Duplicate removal gave 990 unique articles. After a thorough search for title and article relevance, only 25 most relevant studies were left. Quality assessment tools like Universal Questionnaire, Cochrane Risk Assessment, Scale for Assessment of Narrative Review Article (SANRA) and Assessment of Multiple Systematic Review (AMSTAR) were applied to our 25 articles and 15 most reliable ones were extracted. This systematic review includes 37854 patients outcome in its discussion. Conclusions: Depression in MI patients can occur due to multiple factors related to patients' characteristics and disease burden. SSRIs and other pharmacotherapies can cause fatal outcomes in a patient with compromised heart function. However, other therapies like CBT and ET are more suitable for MI patients due to low to no side effects profile. This systematic review helps physicians and researchers in selecting the most appropriate antidepressant treatment for MI patients.