de Jonge, P.

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   University of GroningenThe importance of incident depression in myocardial infarction patientsde Jonge, P.Published in:Biological PsychiatryIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2009Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):de Jonge, P. (2009). The importance of incident depression in myocardial infarction patients. BiologicalPsychiatry, 65(4), e7-e8.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 20-06-2022CTITisaIwPptaoawf(5satidsut[sidrniddrpuncsmisrntmtitbnwrpib0ORRESPONDENCEhe Importance of Incident Depression in Myocardialnfarction Patientso the Editor:Depression that is present in the aftermath of a myocardialnfarction (MI), post-MI depression, may encompass differentubtypes based on whether it is the first or a recurrent episodend based on its onset (i.e., started before or after the MI).ncident post-MI depression is defined as a first-ever episodeith an onset after the MI. In a recent issue of Biologicalsychiatry, Parker et al. (1) confirm that the association betweenost-MI depression and prospective cardiovascular events is dueo those episodes that develop just after the cardiac event.Although some still believe the results in this area of researchre inconclusive (2), summarizing the evidence reveals there isnly one relatively small study (n  222) from 1996 by Lesper-nce et al. (3) suggesting that recurrent depression is associatedith an increased risk of cardiac events. In contrast, there areour larger and more recent studies, namely by Grace et al. (4)n  750), de Jonge et al. (5) (n  468), Dickens et al. (6) (n 88), and recently the study by Parker et al. (1) (n  489),uggesting that it is incident depression that is most stronglyssociated with prospective cardiovascular events. Apart fromhe larger sample sizes of these more recent studies, it ismportant to note that the estimated increased risk of post-MIepression on survival has dramatically decreased from the earlytudies by Frasure-Smith et al. (7) (hazard ratio [HR]  5.8,nadjusted effect) to more recent, meta-analytic based estima-ions of around 2 (van Melle et al. [8]: HR  2.4; Nicholson et al.9]: HR  1.8; Barth et al. [10]: HR  2.2). As a result, the earliertudies may no longer accurately reflect the actual risk.Some recent studies have also shown that incident depressions associated with aspects of MI severity (11) and coronary arteryisease (CAD) severity (12), suggesting a different etiology thanecurrent depression. This is not to say that post-MI depression isecessarily an artifact, although in part it may be, but at least thatt may be a specific kind of reaction that is different from normalepression. Among the possible mechanisms of how post-MIepression may lead to impaired cardiovascular prognosis, theole of inflammation and low heart rate variability have beenroposed (13). Both are associated with the severity of thenderlying heart disease, depression, and cardiovascular prog-osis. Of interest, both increased inflammation (14) and de-reased heart rate variability (15) are specifically associated withomatic, rather than cognitive, symptoms of depression, whichay be more prevalent in incident depression. In other words,ncident post-MI depression may be a condition in which depres-ion and heart disease are truly intertwined.The finding that incident post-MI depression, relative toecurrent depression, is distinctively associated with subsequentegative cardiac outcomes is of utmost interest with respect toreatment options. The presence of incident post-MI depressionay help to explain the disappointing results from interventionrials aimed to treat post-MI depression and thereby attempting tomprove cardiovascular prognosis (16–18). Thus far, the distinc-ion between incident depression and recurrent depression haseen found helpful in distinguishing response to treatment inon-CAD depressed patients (19–21), in which only subjectsho had repeated past episodes responded to therapy. With theesults presented by Parker et al. (1), it is possible that in MIatients, we are currently able to effectively treat depression thats not associated with an increased risk of cardiovascular eventsut not depression that is associated with increased risk, as006-3223/09/$36.00observed in the Sertraline AntiDepressant Heart Attack Trial(SADHART) (16). The result is a failure to improve cardiovascularprognosis by treating post-MI depression as observed in theEnhancing Recovery in Coronary Heart Disease Patients, orENRICHD, trial (17), and the Myocardial INfarction and Depres-sion Intervention Trial, or MIND-IT (18). The presence of inci-dent post-MI depression therefore urges us to keep our eyesopen to new developments in this rapidly expanding area ofresearch and to develop new interventions that might be quitedifferent than what has been tried before.Peter de JongeInterdisciplinary Center of Psychiatric EpidemiologyDepartment of PsychiatryUniversity Medical Centre GroningenUniversity of GroningenHanzeplein 1 Gebouw 32PO Box 30 0019700 RB GroningenThe NetherlandsDr. de Jonge reports no biomedical financial interests orpotential conflicts of interest.1. Parker GB, Hilton TM, Walsh WF, Owen CA, Heruc GA, Olley A, et al.(2008): Timing is everything: The onset of depression and acute coro-nary syndrome outcome [published online ahead of print July 2]. BiolPsychiatry.2. De Jonge P, Ormel J (2008): Heterogeneity of patients with coronaryartery disease and distress and the need to identify relevant subtypes.Arch Gen Psychiatry 65:851– 852; author reply 852– 853.3. Lesperance F, Frasure-Smith N, Talajic M (1996): Major depression be-fore and after myocardial infarction: Its nature and consequences. Psy-chosom Med 58:99 –110.4. Grace SL, Abbey SE, Kapral MK, Fang J, Nolan RP, Stewart DE (2005):Effect of depression on five-year mortality after an acute coronary syn-drome. Am J Cardiol 96:1179 –1185.5. de Jonge P, van den Brink RH, Spijkerman TA, Ormel J (2006): Onlyincident depressive episodes after myocardial infarction are associatedwith new cardiovascular events. J Am Coll Cardiol 48:2204 –2208.6. Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A,Creed F (2008): New onset depression following myocardial infarctionpredicts cardiac mortality. Psychosom Med 70:450 – 455.7. Frasure-Smith N, Lespérance F, Talajic M (1993): Depression followingmyocardial infarction. Impact on 6-month survival. JAMA 270:1819 –1825.8. van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, vanVeldhuisen DJ, et al. (2004): Prognostic association of depression follow-ing myocardial infarction with mortality and cardiovascular events: Ameta-analysis. Psychosom Med 66:814 – 822.9. Nicholson A, Kuper H, Hemingway H (2006): Depression as an aetiologicand prognostic factor in coronary heart disease: A meta-analysis of 6362events among 146 538 participants in 54 observational studies. EurHeart J 27:2763–2774.10. Barth J, Schumacher M, Herrmann-Lingen C (2004): Depression as a riskfactor for mortality in patients with coronary heart disease: A meta-analysis. Psychosom Med 66:802– 813.11. Spijkerman T, de Jonge P, van den Brink RH, Jansen JH, May JF, Crijns HJ,Ormel J (2005): Depression following myocardial infarction: First-everversus ongoing and recurrent episodes. Gen Hosp Psychiatry 27:411–417.12. Goodman J, Shimbo D, Haas DC, Davidson KW, Rieckmann N (2008):Incident and recurrent major depressive disorder and coronary arterydisease severity in acute coronary syndrome patients. J Psychiatr Res42:670 – 675.13. Carney RM, Freedland KE, Miller GE, Jaffe AS (2002): Depression as a riskfactor for cardiac mortality and morbidity: A review of potential mech-anisms. J Psychosom Res 53:897–902.BIOL PSYCHIATRY 2009;65:e7–e8© 2009 Society of Biological Psychiatry1111e8 BIOL PSYCHIATRY 2009;65:e7–e8 Correspondencew4. Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW (2008): Frominflammation to sickness and depression: When the immune systemsubjugates the brain. Nat Rev Neurosci 9:46 –56.5. de Jonge P, Mangano D, Whooley MA (2007): Differential association ofcognitive and somatic depressive symptoms with heart rate variabilityin patients with stable coronary heart disease: Findings from the Heartand Soul Study. Psychosom Med 69:735–739.6. Glassman AH, Bigger JT, Gaffney M, Shapiro PA, Swenson JR (2006):Onset of major depression associated with acute coronary syndromes:Relationship of onset, major depressive disorder history, and episodeseverity to sertraline benefit. Arch Gen Psychiatry 63:283–288.7. Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, etal. (2003): Effects of treating depression and low perceived social sup-port on clinical events after myocardial infarction: The Enhancing Re-covery in Coronary Heart Disease Patients (ENRICHD) randomized trial.JAMA 289:3106 –3116.ww.sobp.org/journal18. van Melle JP, de Jonge P, Honig A, Schene AH, Kuyper AM, Crijns HJ, et al.(2007): Effects of antidepressant treatment following myocardial infarc-tion. Br J Psychiatry 190:460 – 466.19. Teasdale JD, Segal ZV, Williams JMG, Ridgeway VA, Soulsby JM, Lau MA(2000): Prevention of relapse/recurrence in major depression by mind-fulness-based cognitive therapy. J Consult Clin Psychol 68:615– 623.20. Ma SH, Teasdale J (2004): Mindfulness-based cognitive therapy for de-pression: Replication and exploration of differential relapse preventioneffects. J Consult Clin Psychol 72:31– 40.21. Bockting CLH, Schene AH, Spinhoven Ph, Koeter MWJ, Wouters LF,Huyser J, Kamphuis JH (2005): Preventing relapse/recurrence in recur-rent depression with cognitive therapy: A randomized controlled trial. JConsult Clin Psychol 73:647– 657.doi:10.1016/j.biopsych.2008.08.024

The importance of incident depression in myocardial infarction patients

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The importance of incident depression in myocardial infarction patients

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