Introduction

Many subjects, suffering from a first myocardial infarction (MI), describe a lack of energy, excess fatigue, listlessness, a loss of libido and increased irritability as their most dominant feelings in the months prior to this cardiac event (Appels & Mendes de Leon, 1989; Falger, 1989). A prospective study (average follow-up period 4.2 years), in which the association of these feelings with future MI was explored, showed that subjects, suffering from these feelings, had at least a two-fold increase in risk for future MI (Appels & Mulder, 1988). The aforementioned studies suggest that a lack of energy, excess fatigue, listlessness, loss of libido and increased irritability are important premonitory symptoms for MI.

These feelings reflect a state of exhaustion which people develop when their resources to adapt to stress break down (Appels, 1989). These feelings are also reported by subjects suffering from depression (DSM-III-R, 1987) leading to the question whether exhausted subjects are also suffering from depression. An association between depression and coronary heart disease has been previously reported by Crisp, Queen & d'Souza (1984) and Booth-Kewley & Friedman (1987). Current psychiatric consensus on depression is that depression is a complex of cognitive, behavioral, motivational and somatic symptoms that manifest themselves around a core symptom of depressed mood (DSMIII- R, 1987). The assessment of depression, however, is problematic (Bouman, 1987) because both kind and severity of symptom components show considerable inter-individual variability.