At some period during the recovery from a myocardial infarction, depression frequently sets in. This may occur as early as 3 to 5 days after the myocardial infarction or surgery, or appear later after the patient has left the hospital. It has been likened to the mourning for a loss: in this case a sense of lost potential or lost physical ability. Generally the depression is transient and talking about the patient’s concerns may be the best treatment. A patient’s stress level can be markedly reduced through reassurance as to the normalcy and transcience of such conditions as physical weakness and memory lapses and by open discussion of financial and domestic problems that are worrisome. Authoritative information can dispel concerns caused by harmful “myths” about cardiac conditions and aid in adaptive coping by but both patients and family. It has been pointed out that appropriate information contributes to the adaptive coping by correcting unrealistic appraisals of threat, by reducing uncertainty and thus increasing the sense of control, and by suggesting more appropriate coping strategies.

At times, the patient may become depressed after returning home, even if there are no signs during hospitalization. The symptoms may be manifested by "somatization" with symptoms such as pain and fatigue instead of or in addition to mental signs.

If the physician is aware of depression, he or she can reassure the patient that such feelings are to be expected and usually pass in a short time. If the patient is taking medications that tend to aggravate depression such as cimetidine, methyldopa, guanethidine, reserpine or beta blockers, modifications in treatment should be considered. No other therapy may be necessary, but close follow-up is required. Antidepressant medication or professional psychiatric care may be indicated in some cases. Participation in a formal rehabilitation program is frequently helpful. Loss of appetite, insomnia , feelings of isolation, and general apathy are among the signs that may indicate serious depression. Pharmacological treatment may be required for only a few weeks. Ordinarily, if anxiety and depression that follow bypass surgery or myocardial infarction have not been resolved by 3 to 6 months, professional psychiatric care is indicated.

Because of their potential adverse cardiac effects, it is frequently not desirable to employ the usual antidepressant agents for six weeks after bypass procedure or myocardial infarction or for a patient having arrhythmias. Actually, it is rare for such patients to suffer a severe endogenous depression - the sort in which they lose their serotonin and norepinephrine, the neurotransmitters help control normal mode - in the first six weeks. In such patients alprazolam can be helpful,especially if the patient displays a lot of anxiety, as is often the case. It appears to be as effective as imipramine and to produce its effect faster.

The patient’s family or "significant other" also may require help to deal with the stress of the situation, which usually involves heightened responsibilitie as well as care of an agitated patient. The crisis situation of the heart attack or the cardiac surgery and the resulting role changes and stresses can unleash emotional problems up to two years later and may have an adverse affect on relationships.

Although cardiac rehabilitation programs are usually thought of as primarily exercise programs, they also offer psychological benefits that tend to help resolve transient depression. With many special medical conditions, other patients who have been through the experience can provide meaningful psychological support. There is empathy among the members and they encourage each other. Patients who have participated in a comphrehensive rehabilitation program for more likely to return to work and to report more satisfactory quality of life. Patients who are deemed ineligible for an exercise program may be the ones needing more psychological counseling.