Patients with a first myocardial infarction (MI) frequently report symptoms of depression but are less likely to receive treatment with antidepressants, compared to those who have not had a heart attack. The findings are part of new study presented at EuroHeartCare 2016.

The authors administered questionnaires to 805 patients under 75 years of age who had a first MI, and a control group, matched for age, gender and location, of 805 with no record of MI. The participants graded the level of stress they felt at home, work and related to their economical situations. They were also asked about stressful events that occurred in the last year and their perceptions of control in life.

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The results showed that 14% of MI patients had symptoms indicative of depression compared to 7% of the control group. Of depressed patients, just 16% of MI patients with depression received antidepressants compared to 42% of controls with depression.

Additionally, a higher number of MI patients reported experiencing stress at home (18%) and work (42%), compared with controls who reported 11% and 32%, respectively. Patients who had symptoms of depression or exhaustion had double the chances of heart attack.

“Our results suggest that heart attack patients are undertreated with antidepressants,” said Dr Barbro Kjellström, Karolinska Institute in Stockholm, and lead author of the study. “It appears that patients who had a heart attack did not seek help for their depression, or if they did, their symptoms were not accurately recognised and managed.” While cognitive therapies were not assessed in this trial, the researchers point out that these were unlikely to fill the large gap in treatment.

Dr Kjellström expanded on the study’s results, detailing the repercussions stress can have, as established by the study results. “If you have enough stress you might get exhaustion which, if not treated, can result in depression,” said reported, “This is an escalating scale. Prevention of stress, exhaustion and depression is the optimal goal.”

These findings make up part of a substudy of the wider ‘PAROKRANK’ study, which explored the relationship between periodontitis and increased risk of myocardial infarction.

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