12.00 TREATMENT OF POST MI DEPRESSION
When depression is suspected in an MI patient or the screening tool reveals depressive symptoms, the patient needs to be referred to a Psychiatrist for further management. Adequate and prompt management of depression can improve the quality of life in MI patients . When depression has been managed, CAD patients are more likely to be compliant to medications, regular doctor check-ups and modify their lifestyle (95). However there is insufficient evidence of better prognosis in MI patients who have been treated for their depression (147).
The therapeutic interventions in post MI depression consist of (67):
a. Antidepressant treatment
B. Cardiac rehabilitation
C. Cognitive behavioural therapy (CRT)
12.10 ANTIDEPRESSANTS
The safety of antidepressant use in patients who have suffered MI is unclear. SSSRIs are the preferred first-line treatment for depression as they are safer in patients with cardiovascular disease and it was found to be more effective in post MI depression (41), (77). Some studies suggest that cardiac risk is reduced with SSRIs as it reduces the sympathetic nervous activity (154) while other studies found that SSRIs have no influence over the conduction system in the heart or on fast sodium channels (155). Analysis of antidepressants in the ENRICHD trial indicated …show more content…
The abnormal neuronal noradrenaline reuptake in TCAs could increase the sympathetic activation of the heart (153). It can increase the heart rate and cause orthostatic hypotension (160). The TCA induced orthostatic hypotension can be further aggravated on MI patients who are taking beta blockers and angiotensin converting enzyme inhibitors (161). They may also alter the conduction system and be more vulnerable to ventricular arrhythmia (162). TCAs are advised to be avoided in ischaemic heart disease and ventricular
When depression is suspected in an MI patient or the screening tool reveals depressive symptoms, the patient needs to be referred to a Psychiatrist for further management. Adequate and prompt management of depression can improve the quality of life in MI patients . When depression has been managed, CAD patients are more likely to be compliant to medications, regular doctor check-ups and modify their lifestyle (95). However there is insufficient evidence of better prognosis in MI patients who have been treated for their depression (147).
The therapeutic interventions in post MI depression consist of (67):
a. Antidepressant treatment
B. Cardiac rehabilitation
C. Cognitive behavioural therapy (CRT)
12.10 ANTIDEPRESSANTS
The safety of antidepressant use in patients who have suffered MI is unclear. SSSRIs are the preferred first-line treatment for depression as they are safer in patients with cardiovascular disease and it was found to be more effective in post MI depression (41), (77). Some studies suggest that cardiac risk is reduced with SSRIs as it reduces the sympathetic nervous activity (154) while other studies found that SSRIs have no influence over the conduction system in the heart or on fast sodium channels (155). Analysis of antidepressants in the ENRICHD trial indicated …show more content…
The abnormal neuronal noradrenaline reuptake in TCAs could increase the sympathetic activation of the heart (153). It can increase the heart rate and cause orthostatic hypotension (160). The TCA induced orthostatic hypotension can be further aggravated on MI patients who are taking beta blockers and angiotensin converting enzyme inhibitors (161). They may also alter the conduction system and be more vulnerable to ventricular arrhythmia (162). TCAs are advised to be avoided in ischaemic heart disease and ventricular