Should patients with coronary heart disease and depression be given antidepressants?

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Patients with coronary heart disease are susceptible to depression and this comorbidity makes cardiovascular outcomes worse.

Using antidepressants to treat depression in patients with other health conditions is sometimes quite controversial.

This meta-analysis looked at the health effects of selective serotonin reuptake inhibitors (SSRIs) versus placebo or no antidepressants in patients with coronary heart disease (CHD) and depression. Observational studies and randomized controlled trials were found with a decent search. Primary outcomes were readmission for CHD (including myocardial infarction, unstable angina, and stroke) and all-cause mortality; the secondary outcome was severity of depression symptoms.

When only properly randomized trials were considered (n = 734 patients), patients on SSRIs showed no significant differences in mortality (risk ratio 0.39, 95% confidence interval 0.08 to 2.01) or CHD readmission rates (0.74, 0.44 to 1.23) compared to controls.

Conversely, when all studies were included, SSRI use was associated with a significant decrease in CHD readmission (0.63, 0.46 to 0.86) and mortality rates (0.56, 0.35 to 0.88). A significantly greater improvement in depression symptoms was always apparent in patients on SSRIs with all selected indicators.

The authors concluded:

In patients with CHD and depression, SSRI medication decreases depression symptoms and may improve CHD prognosis.

This carefully conducted review shows that there is still only limited evidence for the use of SSRIs in patients with CHD and depression.  There does appear to be a benefit for SSRI therapy in cardiovascular compromised patients regarding death and readmissions.

Perhaps the more interesting finding is the absence of harm in depressed patients with coronary heart disease treated with SSRIs.

Links

Pizzi C, Rutjes AW, Costa GM, Fontana F, Mezzetti A, Manzoli L. Meta-analysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease. Am J Cardiol. 2011 Apr 1;107(7):972-9. Epub 2011 Jan 20. [PubMed abstract]

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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