Heart attack patients receive less treatment for depression

People who have suffered a heart attack are more depressed but are less often prescribed antidepressants than those who have not had a cardiac arrest, a new study has found.
"What was new and astonishing was that heart attack patients less often receive treatment for depression," said Barbro Kjellstrom from Karolinska Institute in Sweden.
The study included 805 patients under 75 years of age who had experienced a first myocardial infarction and 805 people without a myocardial infarction (the control group) matched for age, gender and where they lived.
Detailed information was collected on stress, depression and exhaustion using well established, validated questionnaires.

Participants were asked to grade the level of stress they felt at home and at work and about their economical situation. They were also asked about stressful events during the past year and their feeling of control in life, both at work and at home.
The participants were 62 years old on average and 81 per cent were men. Researchers found that 14 per cent of patients had symptoms of depression compared to just 7 per cent of controls.

Symptoms of depression or exhaustion were associated with a doubled risk of heart attack. When researchers looked at types of stress, they found that more patients than controls had experienced stress at home (18 per cent compared to 11 per cent) and at work (42 per cent versus 32 per cent).

Even moderate levels of stress at home were associated with a doubled heart attack risk, researchers said.
"Patients who had a heart attack had more stress both at work and at home but interestingly there was no difference between the two groups as regards to financial stress," said Kjellstrom.
"Patients also reported that they had less control of their work situation. In addition, those who had a heart attack were more likely to be divorced whereas people in the control group more often lived with a partner," she said.
"When asked 'Were you angry during the last 24 hours?' many more patients said yes compared to controls. It appears that stress in life can also trigger feelings of anger in patients who have had a heart attack," she added.

Just 16 per cent of heart attack patients with depression received antidepressants compared to 42 per cent of controls with depression, researchers said.
"Our results suggest that heart attack patients are under-treated with antidepressants. When we looked at the participants in the study who had experienced depression we saw that more than twice as many controls as patients were prescribed antidepressant medication," said Kjellstrom.