Effects of Antidepressant Medication on Morbidity and Mortality in Depressed Patients After Myocardial Infarction

Taylor, C. Barr; Youngblood, Marston; Catellier, Diane J.; Veith, Richard C.; Carney, Robert M.; Burg, Matthew M.; Kaufmann, Peter; Shuster, John L.; Mellman, Thomas A.; Blumenthal, James A.; Krishnan, Ranga; Jaffe, Allan S.

doi:10.1001/archpsyc.62.7.792

Cited by 456 publications

(269 citation statements)

References 34 publications

(28 reference statements)

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“…Patients were given antidepressants if severely depressed or unresponsive to CBT [10], and had higher baseline BDI (p < 0.001) and HAM-D (p < 0.001) scores than those not receiving medication. Most patients improved on sertraline but less than those who were not on an antidepressant.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Treatment Response for Depression and Inadequate Social Support – The ENRICHD Randomized Clinical Trial

Cowan

Freedland

Burg

et al. 2007

Psychother Psychosom

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Objective: To determine whether the ‘dose’ of treatment exposure, delivery of specific components of cognitive behavior therapy (CBT), patient adherence and/or use of antidepressants predict favorable depression and social support outcomes after 6 months of cognitive behavioral treatment. Methods: Secondary analyses of the intervention arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial involving persons with acute myocardial infarction (MI): n = 641 for the depression outcomes and n = 523 for the social support outcomes. The outcome measures were, for depression: the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D); for social support: the ENRICHD Social Support Instrument (ESSI) and Perceived Social Support Scale (PSSS). Results: Better depression outcomes (measured by the BDI) were receiving a high number of depression-specific intervention components, p < 0.01, and completing a high proportion of homework assignments, p < 0.02. Better depression outcomes (measured by the HAM-D) were receiving a high number of the social communication and assertiveness components of the intervention, p < 0.01, and completing a high proportion of homework assignments, p < 0.01. Better social support outcomes (measured by the ESSI and PSSS) were predicted by membership in a racial or ethnic minority group, p < 0.02 and p < 0.01, respectively; and by completing a higher number of homework assignments, p < 0.01 and p < 0.05, respectively. Delivery of the social communication and assertiveness components of the intervention was an independent predictor of a worse social support outcome, p < 0.01 (measured by the PSSS). Conclusions: The standard components of CBT for depression are useful in treating comorbid depression in post-MI patients. Working on communication skills may help to improve depression but not necessarily social support outcomes in this patient population, while adherence to cognitive-behavioral homework assignments is important for both outcomes. Other components of the ENRICHD intervention that were designed to improve social support had no discernible effects on outcomes. Intervention refinements may be needed in order to achieve better results in future post-MI clinical trials. A greater emphasis on CBT homework adherence could improve both depression and social support outcomes.

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Section: Discussionmentioning

confidence: 99%

“…The criteria for antidepressant use in the ENRICHD trial have been published elsewhere [9, 10]. For this analysis, a dichotomous indicator (yes/no) of whether the patient was taking an antidepressant at any point between randomization and the 6-month outcome evaluation was used.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Treatment Response for Depression and Inadequate Social Support – The ENRICHD Randomized Clinical Trial

Cowan

Freedland

Burg

et al. 2007

Psychother Psychosom

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“…Another RCT found fluoxetine to be safe and useful for MI patients with depression (61). Further evidence on the effectiveness of SSRI has been reported in a post hoc analysis of Enhancing Recovery in Coronary Heart Disease (EN-RICHD), where patients receiving SSRIs, experienced more than trial, a 40% decline in the risk of cardiac mortality and reinfarction over a mean follow-up of 29 months, compared to those not taking SSRIs (62).…”

Section: Pharmacotherapymentioning

confidence: 98%

A Narrative Review of the Relationship Between Coronary Heart Disease and Anxiety

Dahale

Menon

Jaisoorya

2017

Iran J Psychiatry Behav Sci

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Context: Coronary heart disease (CHD) is the most common cause of death and disability in the world. While the relationship between depression and CHD is well documented, anxiety remains understudied, despite its common cooccurrence. Evidence Acquisition: A PubMed (MEDLINE) search was conducted in order to find articles published between January 2000 and December 2015, using the following keywords: "coronary heart disease" and "anxiety". In total, 79 out of 1138 articles were considered relevant by consensus between the authors and were reviewed. Results: According to previous studies, anxiety is suggested to increase the risk of CHD. Anxiety is associated with an increase in cardiac complications, morbidity and mortality. Also, a lower quality of life has been described among patients after acute coronary syndrome, with a few studies reporting contradictory findings. Although studies on anxiety management in CHD are sparse, selective serotonin reuptake inhibitors have been shown to be relatively safe for patients. On the other hand, psychological interventions have not been adequately evaluated, although some studies have revealed their advantages. Conclusions: Evidence suggests that anxiety is associated with the development and course of CHD. Awareness and appropriate training in cardiology settings need to be prioritized to improve early identification and initiation of effective management.

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“…During a mean follow-up of 29 months, 457 fatal and nonfatal cardiovascular events occurred. The risk of death or recurrent MI was significantly lower in patients taking SSRIs [55]. The risk of all-cause mortality was also significantly reduced, as well as the incidence of recurrent MI.…”

Section: Randomized Studiesmentioning

confidence: 99%

Depression and Heart Disease: Therapeutic Implications

Somberg

Arora

2008

Cardiology

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The consequences of depression and coronary artery disease (CAD) were reviewed in the literature. The comorbidity of depression and CAD results in an increased cardiovascular mortality. We reviewed possible explanations for this increased morbidity, which include: toxicity of tricyclic antidepressants that can cause cardiac arrhythmias, abnormalities in platelet function leading to increased platelet aggregation due to abnormalities in serotonin in the platelet (an abnormality that possibly causes depression in the central nervous system), diffuse atherosclerosis causing central nervous system abnormalities including depression (vascular depression), as well as the possibility that depressed patients are less compliant with their medications and physician-directed health recommendations. Recent reports of selective serotonin reuptake inhibitors (SSRIs) causing a reduced cardiovascular mortality may be related to serotonin platelet abnormalities in depressed patients that are effectively treated by SSRIs (SADHART and ENRICHD trial). It is possible that these trials reveal a mechanism of depression that also effects platelet function and can be improved with SSRI therapy, suggesting a preferential therapeutic pathway for the treatment of depressed patients with CAD.

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Effects of Antidepressant Medication on Morbidity and Mortality in Depressed Patients After Myocardial Infarction

Abstract: Use of selective serotonin reuptake inhibitors in depressed patients who experience an acute MI might reduce subsequent cardiovascular morbidity and mortality. A controlled trial is needed to examine this important issue.

Cited by 456 publications

References 34 publications

Predictors of Treatment Response for Depression and Inadequate Social Support – The ENRICHD Randomized Clinical Trial

Predictors of Treatment Response for Depression and Inadequate Social Support – The ENRICHD Randomized Clinical Trial

A Narrative Review of the Relationship Between Coronary Heart Disease and Anxiety

Depression and Heart Disease: Therapeutic Implications

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