Antidepressants May Lower Risk of Recurrent Heart Attack and Death In Depressed Heart Attack Patients
Heart Attack and Depression
In depressed patients who have experienced a heart attack, use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), was associated with a reduced risk of death and recurrent heart attack, according to an article in the July issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
Cardiovascular disease (CVD) is the leading cause of death, major disease and disability among U.S. men and women, according to background information in the article. Major depression was found in approximately 20 percent of patients with a recent myocardial infarction (MI; heart attack); a similar prevalence was found for minor depression. Depression is a risk factor for recurrent non-fatal heart attack and cardiac death in patients who experience an acute MI (AMI), independent of cardiac disease severity. Despite their effectiveness in treating depression, the use of antidepressants in patients with CVD remains controversial.
C. Barr Taylor, M.D., from Stanford Medical Center, Stanford, Calif., and colleagues conducted a secondary analysis of data from the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial to determine the effects of antidepressants on post-MI patients. The ENRICHD trial randomized 2,481 depressed and/or socially isolated patients from October 1, 1996 to October 31, 1999. The analysis in this report is based on 1834 patients (985 men and 849 women) who had depression, with or without low social support. Of these, 446 patients took antidepressants during the study, including 301 who were prescribed SSRIs (a class of drugs that increases the levels of serotonin in the body); and 145 patients who were prescribed other types of antidepressants.
During an average follow-up of 29 months, 457 fatal and non-fatal cardiovascular events occurred. Twenty-six percent (361 of 1,388) of the patients who did not receive antidepressants died or had a recurrent MI, compared to 21.5 percent (96 of 446) of the patients who did take antidepressants. After adjusting for baseline depression and cardiac risk, SSRI use was associated with 43 percent lower risk of death or recurrent non-fatal MI, and 43 percent lower risk of death from all causes, compared with patients not receiving SSRIs. Risk of death or recurrent MI, all-cause death, or recurrent MI was 28 percent, 36 percent, and 27 percent lower, respectively, in patients taking non-SSRI antidepressants, compared with nonusers.
"The main finding of this study is that antidepressant use post-AMI by depressed patients in the ENRICHD clinical trial was associated with significantly lower rates of the study primary end points, death and reinfarction [recurrent heart attack]," the authors write.
(Arch Gen Psychiatry. 2005;62:792-798) - Chicago