Anti-Depressant Use Associated With Increased Risk for Heart Patients
Antidepressants and Heart
In a surprising finding, patients with coronary artery disease who take commonly used antidepressant drugs may be at significantly higher risk of death, Duke University Medical Center researchers have found.
Even after controlling for such factors as age, degree of heart disease and severity of depression, the researchers found that heart patients taking antidepressant medications had a 55 percent higher risk of dying. Previously, Duke researchers reported that the presence of depression is an important risk factor for heart patients. This new finding of the risk from anti-depressants raises issues about the optimal way to treat depression in cardiac patients, the researchers said.
According to Duke team leader Lana Watkins, Ph.D., the researchers believe their findings add further support for the potential role oft non-pharmocological approaches to treating depression, such as exercise, in reducing the risk of death in depressed heart patients. She said that physicians caring for heart patients who are taking antidepressants should monitor patients closely.
Watkins added that the design of the study prevents definitive conclusions regarding the effects of antidepressant drugs. In the current observational study, patients were not randomized to receive an antidepressant or a placebo drug, therefore characteristics of the patients, such as more likelihood for their depression or their medical condition to worsen, may be responsible for the effects, she said.
Randomized placebo-controlled trials are needed to not only replicate the Duke findings, but to better understand whether antidepressant use is identifying patients likely to have more severe or worsening depression or worsening medical disease during the follow-up period, Watkins added.
"This finding that antidepressant use was an independent risk factor for mortality in patients with coronary artery disease was quite unexpected," said Watkins, who presented the results of the Duke study March 4, 2006, at the annual meeting of the American Psychosomatic Society in Denver. The research was supported by the National Heart, Lung, and Blood Institute.
"We were surprised since antidepressants, particularly the newer class of antidepressants known as selective serotonin reuptake inhibitors (SSRI), have been generally considered safe," Watkins said. "However, even after taking into account many patient variables, as well as the type of antidepressant, the risk still remained. So there is something important going on here that we don't fully understand."
During the past decade, cardiologists and physicians have gained a greater appreciation that depression should be considered as an important risk factor for patients with coronary artery disease, said the researchers. For this reason, they have increasingly prescribed antidepressants for these patients; however, this increase in use has not been accompanied by conclusive scientific data on the effects of antidepressants