Antidepressive Therapy in Myocardial Infarction, Prevents Recurrent Cardiovascular Events?

There is an endorsement from American Heart Association that depression should be considered a risk factor of heart disease and recommends its screening as part of routine practice. However, all experts do not agree due to controversy on account of inconsistencies in the evidence linking treatment of depression to improved outcomes in Cardiovascular Diseases (CVDs). Further evidence indicates that chrono-behavioral and chronophysiological dysfunctions can predispose traditional risk factors of CVDs as well as other psychological disorders including depression. Recently, reduced duration of sleep which is a risk factor of depression has also been reported to be risk factors of CVDs. Chronic mood disorders such as depression are also known to predispose acute Myocardial Infarction (MI). The incidence of depression may be three-fold higher among Acute Coronary Syndrome (ACS) patients compared to the control subjects. Therefore, there is a need to treat depression to prevent CVDs. Depression can increase amygdalar activity in the brain, which could be examined as tremors in the amygdala by Functional Magnetic Resonance Imaging (fMRI). The activation of amygdala may be associated with increased bone marrow activity and inflammation with increased hsCRP. Western diet is a possible risk factor of depression as well as myocardial infarction, and both are associated with oxidative stress and inflammation. Hence Mediterranean styles diets that are anti-inflammatory, may be used for the preventions of both the diseases. Recent clinical trials in subjects with depression after recent myocardial infarction revealed that antidepressant therapy with escitalopram can cause a lower risk of major cardiovascular events. Further studies are needed to establish the role of antidepressants, along with Mediterranean style diets, in the management of depression in patients with ACS.