Depression after heart attack: Is there a link between depression and heart problems?

Many people become depressed after having a heart attack, and depression can make heart problems worse. Relieving depression can improve the quality of life in people who are depressed after a heart attack.

The most common cause of death in industrial countries is myocardial infarction (heart attack). But many people who survive a heart attack develop depression. Milder symptoms of depression usually get better by themselves after a heart attack. However some people develop more major depression, and that could last longer.

Despite the importance of this illness, not enough is known about how common depression is after a heart attack, and how to best handle it. Researchers from the American Agency for Healthcare Research and Quality (AHRQ) systematically reviewed the evidence about this topic. Most of the research they found had been done in the USA and Europe. Among other things, they were interested in:

• How many people become depressed after a heart attack
• How many people were still depressed one or two months after the heart attack
• Whether treatment could help

One conclusion of their study: about one in five people admitted to hospital with a heart attack develops major depression. However many more have milder symptoms of depression.

Some studies show that the majority of people who become depressed while in hospital for a heart attack may still be depressed one to four months after discharge from hospital. Sometimes major depression after a heart attack could be still affecting psychological and physical health as long as five years later.

The researchers confirmed that it is possible that there is a physical connection between depression and heart problems. Major depression can add to the risks of a person who has had a heart attack. It can slow down recovery, worsen quality of life and lead to a small increase in the chances of dying earlier.

The researchers also came to the conclusion that psychological and/or anti-depressant treatment can probably reduce depression after a heart attack. Treatment can improve the quality of life of people who have major depression after a heart attack. But it is still not certain whether or not treatment can reduce the risk of a heart attack or the risk of dying earlier. Some kinds of anti-depressants are not suitable for use by people with heart problems, so it is important to talk to a doctor before using these drugs. If more evidence becomes available on this issue, we will update this information.

In 2007 and 2008, researchers from Canada and the Netherlands also analysed studies about depression and heart attack. Their results confirm the conclusions of the AHRQ researchers. In addition, some research suggests that cognitive behavioural therapy (CBT) might be able to help people people with depression after a heart attack. Cognitive behavioural therapy is a particular type of psychological treatment that aims to help people learn new ways of thinking and behaving to improve their quality of life.

If you would like to know how you could help support someone who is depressed, you can read more in: Strategies for family and friends

© IQWiG (Institute for Quality and Efficiency in Health Care)