Depression Post-Myocardial Infarction: Primary Care Recognition and Management to Decrease Mortality
Rivelli, Christie Marie
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Background: Myocardial infarction (MI) is a serious, life threatening condition with the potential to leave a survivor with a variety of sequelae, including depression. Post-MI depression is present in up to one third of all MI survivors and has been shown to increase the risk of mortality up to three fold. Purpose: The purpose of this paper was to review current practices in the recognition and diagnosis of post-MI depression, treatment options, and the potential benefits associated with primary care recognition and management of post-MI depression. Data Sources: Data for this article was obtained from several databases, including CINAHL, Academic Search Complete, and MEDLINE. Also, the CDC website was utilized, as was Up-to-Date. Conclusions: Many sources have determined a correlation between post-MI depression and poorer outcomes. Recognition and management of this depression has the potential to improve outcomes and decrease mortality following an MI. There are several effective tools to assist with the assessment of depression, including the two question and nine question personal health questionnaires (PHQ2 and PHQ9 respectively) and the Beck Depression Index (BDI). These tools are easily administered in the primary care setting by trained individuals. Research has also assessed the safety and efficacy of a variety of depression treatment options. Selective Serotonin Reuptake Inhibitors (SSRIs), Cognitive Behavioral Therapy (CBT), and cardiac rehabilitation have been studied and appear to be safe and effective measures to help decrease post-MI depression, thereby helping to decrease mortality in this population. Recognition and management of post-MI depression will assist in improving patient outcomes and decreasing mortality.