Among patients with myocardial infarction (MI) who subsequently develop depression, a lack of response to antidepressants signals a high risk of future cardiac events, according to a subanalysis of data from Myocardial Infarction and Depression-Intervention Trial (MIND-IT)
MIND-IT involved 2,177 patients hospitalized with an acute MI. During follow-up, 375 patients developed post-MI depression, with 209 patients randomized to mirtazapine 30 mg/day, or "care as usual." If there was an inadequate response to mirtazapine after 8 weeks, open treatment with citalopram was allowed in the intervention group.
Dr. Peter de Jonge of the University Medical Center Groningen, the Netherlands, and colleagues report in the American Journal of Psychiatry for September that the recurrent cardiac event rate was 25.6% among nonresponders, 11.2% among untreated control subjects and 7.4% among responders.
After adjustment for potential cofounders, nonresponders had a hazard ratio of 2.92 for new cardiovascular events in comparison to untreated controls.
"This study provides further preliminary evidence that nonresponse to treatment of post-myocardial infarction depression may be associated with cardiac events," the investigators conclude.
"Our present findings leave the possibility open that post-myocardial depression may be causally involved in cardiovascular prognosis," Dr. de Jonge and colleagues add. "However, the actual test for causality has to wait until the long-term course of post-myocardial infarction depression can be altered by more effective treatment
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