Psychoimmunology as a common pathogenetic pathway in myocardial infarction, depression and cardiac death

Depression is prevalent in about 30% during the first 18 months post myocardial infarction (MI). Depression increases the risk of developing cardiac disease, in particular coronary artery disease and cardiac death. It is an independent risk factor for increased post MI cardiac morbidity and mortality, comparable with well-known risk factors such as hypercholesterolaemia. Both coronary artery disease and depressive disorder are highly prevalent and co-morbid, resulting in poor overall prognosis. Therefore understanding the relationship of both disorders, as well as the effects of treatment of depressive and cardiac functioning, is important, not only from the physical health and quality of life perspectives, but also from an economic perspective. In this paper we review the evidence indicating a pivotal role of inflammatory mediators as a common factor in the pathophysiology of MI, depression and cardiac mortality. The effects of antidepressant treatment on these inflammatory mediators in MI-related depression are reviewed.