Depression and myocardial infarction. Implications for medical prognosis and options for treatment.

Depression and myocardial infarction (MI) are closely related. Various pathophysiological mechanisms could link depression to MI, and the different pharmacological and nonpharmacological treatment modalities that could be used have both advantages and disadvantages. Unlike tricyclic antidepressants, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) lack arrhythmogenic effects. In addition to their beneficial effects on depression, SSRIs have positive effects on psychological factors such as anxiety and mood disturbances that are not uncommon in patients who have had an MI. Therefore, these drugs should be preferentially considered for the treatment of depression in MI patients. Studies to further determine the impact of depression on the outcome of MI, and the place of different treatment modalities, are in progress.