Antidepressants may cut risks after heart attack

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In depressed patients who have suffered a heart attack, treatment with the newer types of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) appears to reduce the risk of dying or having another Heart attack in the next few years, researchers have shown.

Depression is a risk factor for illness and death following a Heart attack, Dr. C. Barr Taylor and colleagues note in their report in the Archives of General Psychiatry. Although SSRIs are known to reduce the chances of having a heart attack in the first place, their effect in people who have already had one is unclear.

Taylor, from Stanford Medical Center in California, and his team studied data from a trial involving 1834 patients hospitalized with a heart attack who were subsequently diagnosed with depression.

During an average follow-up period of 29 months, 301 were prescribed an SSRI and 145 were prescribed a different type of antidepressant. Patients were also treated aggressively for their heart disease.

Compared with patients not taking an antidepressant, patients taking an SSRI were almost half as likely to die from any cause or have a recurrent Heart attack. With other types of antidepressants the risk was also reduced, but not as much.

“The results of this study, combined with the epidemiologic and other data,” the researchers conclude, “clearly demonstrate the need for a properly powered, prospective, randomized trial” to determine whether SSRIs can alter outcomes after a heart attack.

In an accompanying commentary, Dr. Alexander H. Glassman, of Columbia University, New York, notes that major depression poses at least as much risk after a heart attack as any other medical risk factor, yet depression is rarely considered in heart attack patients.

The current study, he adds, is “the strongest signal yet that antidepressant drugs can reduce life-threatening events,” and he suggests that treating depression with SSRIs “would save thousands of lives every year.”

SOURCE: Archives of General Psychiatry, July 2005.

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