Effects of antidepressant treatment following myocardial infarction

Abstract

BackgroundDepression following myocardial infarction is associated with poor cardiac prognosis. It is unclear whether antidepressant treatment improves long-term depression status and cardiac prognosis.AimsTo evaluate the effects of antidepressant treatment compared with usual care in an effectiveness study.MethodIn a multicentre randomised controlled trial, 2177 myocardial infarction patients were evaluated for ICD–10 depression and randomised to intervention (n=209) or care as usual (n=122). Both arms were evaluated at 18 months post-myocardial infarction for long-term depression status and new cardiac events.ResultsNo differences were observed between intervention and control groups in mean scores on the Beck Depression Inventory (11.0, s.d.=7.5 v. 10.2, s.d.=5.l, P=0.45) or presence of ICD-10 depression (30.5 v. 32.1%, P=0.68). The cardiac event rate was 14% among the intervention group and 13% among controls (OR=1.07, 95% CI 0.57-2.00).ConclusionsAntidepressant treatment did not alter long-term depression post-myocardial infarction status or improve cardiac prognosis.

Brief Depression Screening with the PHQ-2 Associated with Prognosis Following Percutaneous Coronary Intervention with Paclitaxel-Eluting Stenting

“…Finally, it is possible that the differential prognostic effects of the cutoff scores ≥2 versus ≥3 on the PHQ-2 may be attributed to anti-depressant therapy being more prevalent in patients with the higher cutoff. However, this explanation seems unlikely, given evidence from large-scale trials in cardiac patients 37,38 , showing that antidepressant therapy may reduce depression but not enhance survival. Similarly, it is possible that differences in cardiac medication between the two cutoffs would be responsible for their differential prognostic effects.…”

Depression, Vascular Conditions and Chronicity

“…As for now, randomized controlled trials in CVD-free populations have not yet been carried out. Some trials (SADHART, (Glassman et al 2002); ENRICHD, (Berkman et al 2003); MIND-IT, (van Melle et al 2007)) did investigate the effects of antidepressant psychotherapy or pharmacotherapy on cardiovascular morbidity and mortality in coronary patient populations. Although these studies have shown that depression is treatable in coronary patients, no significant differences were found in medical end-points between intervention and control groups.…”

Longitudinal modelling of theory-based depressive vulnerabilities, depression trajectories and poor outcomes post-ACS

“…Those with elevated depressive symptoms had 25-34% increased risk of deaths per standard deviation increase in depressive symptoms. However, despite the fact that depressive symptoms seem to confer increased mortality risk, the treatment of depression has failed to show any alleviation of risk (The ENRICHD Investigators, 2003; van Melle et al, 2007), thereby calling into question whether depression can truly be seen as a risk factor for MI, or is better seen as a risk marker (Freedland and Carney, 2013;Meijer et al, 2013b). …”