"Renee," a Washington, D.C. career woman, took an early
retirement after she had a heart attack. Many 60-year-olds would have reveled
in such "freedom," but Renee did not. Renee (not her real name),
some of her neighbors suspected, was depressed by her new situation. But then
a few weeks later, Renee had another heart attack while in her apartment and
called 911. By the time the paramedics broke down her door, she was dead.
Was there a link between Renee's post-heart-attack depression and her
subsequent death from another heart attack? A new study suggests that there
could be. It found that when heart-attack patients become depressed a month
after having their attack, they are seven times more likely to have another
attack than are heart-attack patients who do not become depressed at this
A spate of studies have already demonstrated that people who have a heart
attack and who have experienced depression at some point in their lives have a
worse coronary outcome than do people who have a heart attack and who have
never been depressed. Moreover, numerous studies have linked depression around
the time of a heart attack with a poor outcome from that attack. But what has
been unclear is when a depression has to occur in order to pose such risks. So
Gordon Parker, M.D., Ph.D., a professor of psychiatry at the University of New
South Wales in Australia, and his coworkers decided to conduct a study to
answer this question.
They recruited 489 hospitalized heart-attack patients to participate in
their study. The subjects were assessed, on average four days after their
admission, for lifetime and current depression by the Composite International
Diagnostic Interview depression schedule. Out of the 489 subjects, 38 were
found to have experienced a depression at some point earlier in their lives,
and 12 percent were found to be currently depressed—that is, to have
been depressed right before and right after their heart attacks.
A month after the baseline interview, that is, after the subjects had been
discharged from the hospital and were back home, they were contacted by
telephone, and a DSM-IV depression symptom checklist was used to
determine how many who had not been depressed while in the hospital were
depressed at this time point. Ten percent were.
All subjects were followed up during the next 11 months to determine
whether they experienced any more heart attacks. The researchers looked to see
whether depression at any time point could be linked with a subsequent heart
attack. And during their analyses, they considered such potentially
confounding factors as age, gender, cardiac risk factors, antidepressant use,
and current smoking status.
The researchers could find no significant link between depression earlier
in life and a subsequent heart attack. Nor could they find any significant
link between depression right before and after a heart attack and a subsequent
heart attack. But they could find a significant link between
depression that appeared a month after a heart attack and a subsequent heart
In fact, the chances of having a subsequent heart attack were seven times
greater for those heart-attack subjects who were found to be depressed a month
later than for subjects who did not become depressed at this time. In
contrast, recognized cardiac-risk factors such as clogged arteries, stroke, or
diabetes posed considerably lower risks in this regard, the researchers
These findings have some practical implications, Parker and his team
concluded in their study report, which is in press with Biological
Psychiatry. "We suggest that close attention should be paid to how
patients' mood states progress beyond hospitalization."
The findings may also shed light on why depression occurring a month after
a heart attack so often heralds another heart attack. Preliminary research
that Parker and his colleagues have conducted suggests that a depression that
occurs at this time has a biological rather than a psychological origin. And
as they noted in their study report, this biologically triggered depression"
may actually be a signal marker" that something has gone wrong in
the body and have nothing to do directly with causing a heart attack. For
instance, the depression could be a signal that the heart's involuntary
nervous system has started to malfunction.
Indeed, some other researchers have found that depressed heart-attack
patients exhibit dysfunction of the heart's involuntary nervous system and
that such dysfunction in turn can increase a person's chances of dying from a
second heart attack.
The study was funded by Australia's National Health and Medical Research
Council Program and the New South Wales Department of Health.
An abstract of "Timing Is Everything: The Onset of Depression
and Acute Coronary Syndrome Outcome" can be accessed at<www.journals.elsevierhealth.com/periodicals/bps>
by clicking on "Articles in Press." ▪