TY - JOUR
T1 - Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction
AU - Scherrer, Jeffrey F.
AU - Chrusciel, Timothy
AU - Garfield, Lauren D.
AU - Freedland, Kenneth E.
AU - Carney, Robert M.
AU - Hauptman, Paul J.
AU - Bucholz, Kathleen K.
AU - Owen, Richard
AU - Lustman, Patrick J.
PY - 2012/2
Y1 - 2012/2
N2 - Background: Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression. Aims: We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression. Method: Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatmentresistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months. Results: During follow-up of 4037 patients with major depressive disorder who had had a myocardial infarction, 6.9% of those with insufficiently treated depression, 2.4% of those with treated depression and 5.0% of those with treatmentresistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95% CI 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95% CI 1.05-2.79) times more likely to die. Conclusions: All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.
AB - Background: Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression. Aims: We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression. Method: Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatmentresistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months. Results: During follow-up of 4037 patients with major depressive disorder who had had a myocardial infarction, 6.9% of those with insufficiently treated depression, 2.4% of those with treated depression and 5.0% of those with treatmentresistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95% CI 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95% CI 1.05-2.79) times more likely to die. Conclusions: All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.
UR - http://www.scopus.com/inward/record.url?scp=84857094820&partnerID=8YFLogxK
U2 - 10.1192/bjp.bp.111.096479
DO - 10.1192/bjp.bp.111.096479
M3 - Article
C2 - 22241930
AN - SCOPUS:84857094820
SN - 0007-1250
VL - 200
SP - 137
EP - 142
JO - British Journal of Psychiatry
JF - British Journal of Psychiatry
IS - 2
ER -