The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review

Abstract

Objective The purpose of this paper is to review the literature on the impact of antidepressants on depressive symptom severity, quality of life (QoL), morbidity, and mortality in patients with heart failure (HF). Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published from December 1969 to December 2019 that pertain to depression and HF were identified through the use of the PubMed and PsycINFO databases, using the keywords: ‘antidepressant*’ and ‘heart failure.’ Two authors independently conducted a focused analysis and reached a final consensus on 17 studies that met the specific selection criteria and passed the study quality checks. Results Studies varied in types of antidepressants used as well as in study designs. Ten studies were analyzed for the impact of antidepressant medications on depressive symptom severity. Five of these were randomized controlled trials (RCTs), out of which sertraline and paroxetine showed a significant reduction in depressive symptoms despite the small samples utilized. Four of the 17 studies addressed QoL as part of their outcomes showing no difference for escitalopram (RCT), significantly greater improvements for paroxetine controlled release (RCT), statistical significance for sertraline compared to control (pilot study), and showing significant improvement before and after treatment (open-label trial) for nefazodone. Thirteen of the 17 studies included measures of morbidity and mortality. Although early analyses have pointed to an association of antidepressant use and mortality particularly with fluoxetine, the reviewed studies showed no increase in mortality for antidepressants, and secondary analyses showed improved mortality in patients who achieved remission of depressive symptoms. Conclusion Out of the various antidepressants studied, which included sertraline, paroxetine, escitalopram, citalopram, bupropion, nefazodone, and nortriptyline, selective serotonin reuptake inhibitors seem to be a safe treatment option for patients with depression and HF. However, due to the variety of study designs as well as the mixed results for each antidepressant, more information for reducing depression severity, morbidity, and mortality and improving quality of life in patients with HF should be examined using robust large sample RCTs.

Cardiovascular adverse reactions associated with escitalopram in patients with underlying cardiovascular diseases: a systematic review and meta-analysis

“…In a network meta-analysis of 15 RCTs (29) involving participants diagnosed with depressive disorder, and comparing the A prior comprehensive systematic review (30), which included six RCTs, six prospective studies, two cross-sectional studies, two pilot studies, one open-label study, and one secondary analysis involving participants diagnosed with heart failure and comorbid depressive disorder and incorporating various types of pharmacotherapy, including escitalopram, sertraline, and nefazodone, did not yield systematic evidence regarding the effectiveness and safety of escitalopram. This limitation arose from the fact that the findings were primarily based on one RCT (20) and two prospective studies (31,32).…”

Citalopram in the treatment of elderly chronic heart failure combined with depression: A systematic review and meta-analysis

“…It should be noted that SSRIs do cause the QTc prolongation, to a much lower degree than the older tricyclic antidepressants (TCAs) ( 17 ). As such, SSRIs appear to be a safe treatment option for depression in chronic HF patients ( 18 ). Depression can aggravate the patient progress, while the HF can further aggravate the depression.…”

Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis

“…Psychotropic medications are one possible intervention, especially antidepressants like specific serotonin reuptake inhibitors. There is evidence that medications of this type can be an effective treatment with this population (15,17). One challenge for treating depression or anxiety with medication is that patients with HF may be reluctant to add another medication to their regimen (18).…”