There is recent evidence that acute coronary syndrome (ACS) patients with first time incident major depressive disorder (MDD) and those with recurrent MDD represent different subtypes among individuals with ACS and comorbid depression. However, few studies have examined whether or not these subtypes differ in coronary artery disease (CAD) severity. We assessed whether those with incident MDD (in-hospital MDD and negative for history of MDD) or recurrent MDD (in-hospital MDD and a positive history of MDD) differ in angiographically documented CAD severity. Within 1 week of admission for ACS, 88 patients completed a clinical interview to assess current and past diagnosis of MDD. CAD severity was assessed in all patients by coronary angiography. A hierarchical regression analysis showed that neither in-hospital MDD status, nor history of MDD were significant predictors of CAD severity, but the interaction term between in-hospital MDD status and history of MDD was a significant predictor of CAD severity, after controlling for age, sex and ethnicity. Follow-up analyses showed that patients with first-time, incident MDD had significantly more severe CAD compared to patients with recurrent MDD (p = 0.043). To conclude, our study adds to the growing evidence that patients with incident MDD should be considered as a clinically distinct subtype from those with recurrent MDD. Possible mechanisms for differing CAD severity by angiogram between these two subtypes are proposed and implications for prognosis and treatment are discussed.
KeywordsAcute Coronary Syndrome; Coronary Artery Disease; Myocardial Infarction; Angiogram; Incident Major Depressive Disorder; Recurrent Major Depressive Disorder Extensive research has shown that comorbid major depressive disorder (MDD) after an acute coronary syndrome (ACS) event is an independent prognostic marker of increased morbidity and mortality (Barth et al., 2004;van Melle et al., 2004 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Thombs et al., 2006), and of these MDD patients, 50% or more have had depression symptoms in the past. Recent evidence suggests that patients who experience depression after ACS for the first time (incident depression) may represent a clinically distinct subtype when compared with depressed ACS patients who have had depressive symptoms in the past (recurrent depression).
NIH Public AccessThe literature indicates that the extent to which comorbid MDD after ACS impacts future medical prognosis might be dependent on whether patients experience incident or recurrent depression. However, the evidence is mixed ...