Treating Depression in Heart Attack Survivors

Depressed heart attack survivors may lower their risk of a second heart attack or death from heart disease by taking antidepressants.

The finding appears in the Archives of General Psychiatry.

Depression after a heart attack increases the risk of death compared with those who do not suffer from depression.

Death and subsequent heart attack risks were lower in depressed heart attack survivors taking antidepressants, compared with those not taking antidepressants, say the researchers. They included C. Barr Taylor, MD. Taylor works in the psychiatry and behavioral sciences department of Stanford University’s medical school.

Lowest risk was seen in patients taking selective serotonin re-uptake inhibitors (SSRIs), which include Prozac, Celexa, Luvox, Zoloft, or Paxil.

Read Web MD's "Depression Dangerous After Heart Attack."

Depression After Heart Attacks

Depression after a heart attack is common; about one in five heart attack survivors have major depression. A similar number have minor depression after at heart attack, say the researchers.

Depression after a heart attack has been tied to increased risk of heart problems and death.

Depression often goes untreated in heart patients because many doctors are reluctant to prescribe certain types of antidepressants that might make their heart disease worse.

Dutch researchers recently reviewed 22 studies on the topic. Those studies followed more than 6,300 heart attack survivors for up to two years.

Depressed heart attack patients were more than twice as likely to die of any cause as those without depression. They were also 2.5 times as likely to die of heart disease.

Read Web MD's "What Happens During a Heart Attack."

Latest Study

Taylor’s study included 849 women and 985 men. All were depressed heart attack survivors. Some also had little support from family or friends.

They all received an American Heart Association pamphlet on risk reduction. They got either extra care for their depression or routine medical care.

The depression treatment group first got behavioral therapy. If that didn’t help in a few weeks, they started taking antidepressants for up to a year.

After that, patients told their doctors if they wanted to continue treatment.

Read Web MD's "Learn How Antidepressants Work."

Lower Death, Heart Attack Risks

Patients were followed for 29 months, on average.

During that time, 26 percent of patients not taking antidepressants died or had another heart attack compared with 21 percent of patients who took antidepressants.

In those taking SSRIs the risk of death or subsequent heart attack was 43 percent lower, say the researchers. These antidepressants work by blocking the reuptake of the chemical serotonin in the brain and in blood. SSRIs can inhibit blood clotting cells called platelets. Activation of platelets plays a key role in the steps leading to a heart attack.

Other antidepressants were linked to a 28 percent reduction in death or recurrent heart attack risk.

Read Web MD's "Many Emotions Can Damage the Heart."

Researcher’s Comments

“The results basically show that these medications are very useful for patients who have had heart attacks and are depressed,” says Taylor, in a news release.

The study was observational, so it’s not the final word on the topic. It didn’t probe drug safety or which antidepressant is best, say the researchers.

Still, Taylor says the study “provides much stronger evidence than we’ve ever had before that antidepressants are safe and may benefit these patients.”

Controversial Topic

“Although antidepressants are effective in reducing depression, their use in patients with [heart] disease remains controversial,” say the researchers.

“Several studies have found that depression and the use of tricyclic antidepressant medications are associated with an increased risk of [heart] disease.”

In April’s edition of Heart, other researchers suggested that might not be the case.

Taylor’s study was funded by the National Heart, Lung, and Blood Institute, a branch of the National Institutes of Health.

Second Opinion

Only the most depressed patients in Taylor’s study got antidepressants, says Alexander Glassman, MD, in an Archives of General Psychiatry editorial.

There was also no control over when the drug was started or stopped, and even the reported start and stop times were only estimates, says Glassman. He works at the New York State Psychiatric Institute at Columbia University.

Still, the effect’s magnitude is “hard to ignore,” says Glassman.

If death risk had been found to be 40 percent higher with antidepressants, “public advocates would be clamoring for review by the FDA, label changes, or even ‘black box’ warnings,” says Glassman.

While not solid proof, the study is the “strongest signal yet that antidepressant drugs can reduce life-threatening events,” he says.

Acknowledging major depression’s heart and death implications might reduce depression’s stigma, says Glassman.

Health experts urge anyone who suspects depression to seek help, whether or not they’ve had a heart attack.

Visit WebMD's Heart Disease Health Center

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Taylor, C. Archives of General Psychiatry, July 2005; vol 62: pp 792-798. WebMD Medical News: “Depression Dangerous After Heart Attack.” News release, Stanford University Medical Center. WebMD Medical News: “Antidepressants May Not Raise Heart Attack Risk.” Glassman, A. Archives of General Psychiatry, July 2005; vol 62: pp 711-712. News release, JAMA/Archives.