Effects of Treating Depression and Low Perceived Social Support on Clinical Events After Myocardial Infarction

Abstract

Writing Committee for the ENRICHD Investigators C ARDIOVASCULAR DISEASE IS THE leading cause of death and a major cause of morbidity and disability in the United States, with an estimated 6 million people having symptomatic coronary heart disease (CHD). 1 Recent studies 2-7 have shown that depression and low perceived social support (LPSS) are associated with increased cardiac morbidity and mortality in CHD patients. In patients with CHD, the prevalence of major depression is nearly 20% and the prevalence of minor depression is approximately 27%. 8-10 After an acute myocardial infarction (MI), depression is a risk factor for mortality independent of cardiac disease severity. 4,6 A recent randomized clinical trial found that the antidepressant sertraline hydrochloride was effective in treating recurrent depression in patients with either an acute MI or an episode of unstable angina. 11 However, no clinical trial has examined whether treating depression with counseling or antidepressants after an acute MI improves survival or reduces cardiac risk. The absence of social support is also a risk factor for cardiac morbidity and mortality in patients with CHD. 2,3,5,7 No clinical trial has tested the effects of increasing social support on clinical end points following acute MI, although

Social Network Trajectories in Myocardial Infarction Versus Ischemic Stroke

“…Detrimental effects of living alone or reduced perceived social support on outcomes after MI have been reported 18. However, dynamic shifts in social network structure and composition are not reported in the cardiovascular literature, and psychosocial interventions after MI have failed to improve outcomes 19. Therefore, stroke may have a particular effect on sociality that makes patients more vulnerable to social network shrinkage, isolation, and loneliness.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…The largest study to date is the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD). 63 In this study, 2861 patients who had had a myocardial infarction and who had depression or low perceived social support were treated with cognitive behavioral therapy. The aim of the intervention was to "strengthen network ties to be more functional, supportive, and satisfying."…”

“…Although at present there is no evidence that depression treatment offsets the risk of cardiovascular events, 63,201,202 a 2008 American Heart Association science advisory on depression and coronary heart disease, endorsed by the American Psychiatric Association, 203 recommended a specific stepped screening approach to identify patients who may require further assessment and treatment for depression. In an effort to best understand the impact of depression, the symptoms of which are complex, current studies are examining specific depression subtypes that most closely relate to distinct biological underpinnings.…”

Clinical Impact of Subsequent Depression in Patients With a New Diagnosis of Stable Angina

“…Unfortunately, depression is often recurrent in patients with coronary artery disease 24 and, without treatment, is likely to persist. Studies have shown that cognitive behavioral therapy may reduce depressive symptoms, 36 and antidepressants may improve cardiac outcomes, as suggested by a post hoc analysis of the Enhancing Recovery in Coronary Heart Disease Patients trial. 37 The possible benefits of treating depression provide an opportunity to reduce adverse cardiovascular outcomes and their associated costs in this population.…”