Antidepressants can help reduce risk of repeat heart attacks and cardiac death, according to a study led by Stanford University researchers published Monday.
The findings suggest that patients who have already had a heart attack and suffer from depression should talk to their doctors about taking antidepressants to prevent another cardiac event.
The multi-center study by the National Heart, Lung and Blood Institute involved more than 1,800 depressed or socially isolated men and women who had suffered at least one heart attack.
The study’s initial aim was to look at the benefits of psychotherapy in post-heart attack patients. Patients at eight sites around the country were enrolled in three years of individual and group therapy sessions. Those who did not respond topsychotherapy or who had more severe depression were also prescribed the popular antidepressant drug Zoloft.
Researchers found in that study that cognitive behavioral therapy significantly reduced depression but did not reduce death rates from cardiac events.
But there was some evidence that the antidepressants did help reduce risk of death.
So as a follow-up, the researchers looked at the patients’ records over several years since the end of the therapy trial in 1999 to find out more about antidepressant effectiveness.
They found that 28 percent of the participants who had received therapy had used antidepressants, and 20 percent of participants in the control group had.
The median duration of antidepressant use was 12 months for both groups. The patients were most likely to take selective serotonin reuptake inhibitors, or SSRIs, such as Zoloft, Prozac and Paxil.
After adjusting for baseline depression and cardiac risk, SSRI use was associated with 43 percent lower risk of death or recurrent nonfatal heart attack, and
43 percent lower risk of death from all causes.
The findings were published in the July issue of Archives of General Psychiatry.
“The results basically suggest that these medications are very useful for patients who have had heart attacks and are depressed,” Dr. C. Barr Taylor, professor of psychiatry and behavioral sciences at the Stanford University School of Medicine and lead author of the study, said in a statement.
The study does have limitations because it wasn’t designed to evaluate antidepressant use, but rather psychotherapy.
The initial results should be followed up with a controlled randomized trial of antidepressant use to prevent repeat cardiac events, Taylor said.
The study was funded by the National Heart, Lung and Blood Institute, which is part of the National Institutes of Health.
Cardiovascular disease is the leading cause of death, major morbidity and disability in the United States.
It is often linked with depression. Twenty percent of patients with coronary heart disease suffer from major depression and 20 percent from minor depression, according to past studies.
Studies have also shown that depression among post-heart attack patients is associated with death and recurrent heart attacks.
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Posted August 21st, 2007