Introduction
Acute coronary syndrome is a fatal condition with an incidence of 22.6 per 10000 people annually. Depression following acute coronary syndrome is most common, which may lead to increased risk more than heart disease. Major depression is often persistent with acute coronary syndrome resulting in impairment of health conditions than the transient mild or moderate depression. Evident studies show that both life-threatening disorders intercede about 20 to 30 % of the time.
What Is an Acute Coronary Syndrome?
Acute coronary syndrome refers to a range of conditions that occur abruptly, reducing or blocking blood flow to the heart. Any ruptured plaque or fatty deposits cause reduced blood flow in the coronary arteries and, thus, impairment of heart muscle. Based on the duration of the symptoms and electrocardiogram, ECG changes acute coronary syndrome into the three following scenarios.
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ST-elevation myocardial infarction, STEMI, or heart attack is known for diminished or blocked blood flow to the coronary artery.
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Non-ST elevation myocardial infarction, NSTEMI.
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Unstable angina or crescendo angina.
So, unstable angina is when symptoms are less than thirty minutes long. At the same time, acute myocardial infarction is for the symptoms lasting more than thirty minutes.
What Are the Signs and Symptoms of Acute Coronary Syndrome?
The first and cardinal sign of acute coronary syndrome is chest pain that often radiates to the left arm and jaw. The following are the common symptoms experienced in patients with acute coronary syndrome.
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Chest pain or discomfort felt as tightness over the chest.
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Pain radiating to the left arm, upper abdomen, jaw, neck, or back.
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Nausea or vomiting.
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Excessive sweating.
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Shortness of breath.
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Indigestion.
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Dizziness and lightheadedness.
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Unusual fatigue.
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Restlessness.
How Is Depression Associated With Acute Coronary Syndrome?
Depression and coronary disorders in common have a well-established relationship.
Many studies have proved the inflammation and inflammatory response to be the foremost cause of depression after acute coronary syndrome. The following are the common traditional risk factors that mediate depression in cardiac patients.
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Smoking.
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Alcohol abuse.
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Hypertension.
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Lack of exercise and physical activity.
Other behavioral factors also conclude with depression, such as poor lifestyle changes and improper follow-up with medical care.
Is Depression a Cause of Cardiac Mortality?
States of emotional depression accompanying cardiac disorders like acute coronary syndrome are the factors risking cardiac events and mortality.
How to Treat Depression After Acute Coronary Syndrome?
Antidepressant treatment, experimental psychotherapy, and lifestyle modification are widely performed and clinically proven through trials. The early study shows that patients with depression after a cardiac attack responded poorly to the standard treatment. But, newer analyses have suggested cognitive behavioral therapy in groups or individuals with regular follow-ups is effective. Some patients experiencing mild depression after acute coronary syndrome noticed the spontaneous remission of depression even without treatment. But, patients with major persistent depression resulted in adverse coronary artery disease outcomes.
Pharmacological Treatment:
Following acute coronary syndrome, antidepressant therapy showed no effects on mortality but reduced recurrent hospitalizations. And also, patients with depression under antidepressant medications reduced the risk of recurrent myocardial infarction, MI.
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Selective serotonin reuptake inhibitors (SSRIs) such as Citalopram, Escitalopram, Fluoxetine, Paroxetine, and Sertraline are commonly used antidepressants to treat major depression, anxiety, and other psychological conditions.
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Other classes of anti-depressants.
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Adjunctive medications like atypical antipsychotic drugs such as risperidone and olanzapine.
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There should be caution in taking non-adrenergic antidepressant medications for patients with coronary disorder.
Psychotherapy Intervention:
Cognitive behavioral therapy, CBT, or psychotherapy therapy, when combined with antidepressants and other drugs, is more effective. This therapy is done by psychologists, medical counselors, licensed clinical social workers, and medical health trainers. CBT sessions can be in groups sharing each one's experience, or individually with several materials. CBT is chiefly performed as proven talk therapy. Cognitive behavioral therapy has the following features.
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Cognitive restructuring is identifying and correcting unusual cognitive thoughts and depressed feelings. The therapist will first know the reason behind depression and inaccurate thoughts and make them aware of those thoughts. Those depressed thoughts are then converted into positive ones and applied in everyday life.
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Behavioral activation makes patients playfully engage in their life-changing activities. In addition, this enhances one problem-solving skills with proper guidance and tutorial.
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The therapist will give the patient some goals like cessation of alcohol or reduction in depressive thoughts. He also advises not to get thoughts from the past.
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The training comprises ten to twenty sessions, and the duration of therapy differs for each patient.
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Some skills are taught at the end of the session to avoid the recurrence of depression.
Light Therapy:
Exposure to outdoor sunlight or an artificial therapy box mimics outdoor light. This light therapy box induces a chemical change in the brain, which lifts the mood and reduces depression. This also prevents them from tiredness, laziness, and sleeping too much. Also, known phototherapy is traditionally referred to as heliotherapy.
Supportive Strategies:
Several strategies, along with medications and psychotherapy, lower depression, yield the person’s personal growth, environmental status, autonomy, and self-esteem, and gain friendly relationships. Some of the supportive strategies are mentioned below.
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Exercise.
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Self-help guided by a therapist.
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Yoga and meditation.
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Healthy diet.
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Facing the fears.
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Have a routine follow-up.
Prognosis:
The prognosis for significant depression is fair with antidepressant drugs and cognitive behavioral therapy. People with acute coronary syndrome are more likely to intend to depression within thirty days of identification of ACS event or three months of hospitalization. Mild to moderate depression after the coronary disorder is usually recovered with short-term or no treatment.
Conclusion:
Though depression is a serious global health issue affecting patients with coronary disorders, it can be resolved spontaneously using medications, cognitive behavioral therapy, and palliative care.
