Heartening Responses: Depression drugs may aid survival after heart attack

Each year, about 200,000 U.S. survivors of heart attacks or related cardiac problems develop major depression, a condition that sharply boosts their chances of having a potentially fatal heart attack. An analysis of data from a large, federally funded clinical trial indicates that when such patients take antidepressant medication of the class known as selective serotonin reuptake inhibitors (SSRIs), they reap major heart-health benefits.

In the 29 months after experiencing a heart attack, depressed patients who happened to be taking SSRIs displayed only 57 percent as many bad outcomes—new heart attacks and deaths from cardiac causes—as did depressed heart attack survivors who weren’t taking SSRIs. A team led by psychiatrist C. Barr Taylor of Stanford (Calif.) Medical Center reports these findings in the July Archives of General Psychiatry.

“If treating major depression [in people with heart disease] reduced mortality by only half of what this study suggests, it would save thousands of lives every year,” comments psychiatrist Alexander H. Glassman of Columbia University.

However, the results require confirmation in a long-term investigation of depressed patients with heart disease who are randomly assigned to receive SSRIs, Glassman says.

In the past few years, SSRIs have attracted attention because some studies have concluded that the drugs increase the risk that depressed people will attempt suicide (SN: 7/24/04, p. 51: Suicide Watch: Antidepressants get large-scale inspection).

Taylor’s group consulted heath data on 1,834 depressed heart attack survivors who participated in a larger clinical trial called Enhancing Recovery in Coronary Heart Disease (ENRICHD). In 2003, a 6-month follow-up of ENRICHD participants found that cognitive-behavioral therapy produced better moods in depressed patients but didn’t reduce the rate of death from new heart attacks.

In passing, that report mentioned that the 446 depressed patients who had received antidepressant drugs—and who tended to have the more-severe depression—were roughly 60 percent as likely to die or have subsequent heart attacks as other study participants were.

The new report confirms that intriguing result, but only for the 301 individuals who were using SSRIs, Taylor and his coworkers report. Most people in the SSRI group were taking sertraline (Zoloft). No advantages in heart health or survival appeared in 145 patients who received other types of antidepressant medication.

Moreover, patients who stopped taking an SSRI during the 29-month follow-up reverted to the higher mortality and heart attack rates of depressed, non-SSRI users.

Evidence of benefits for depressed heart-attack survivors taking SSRIs first emerged in a 2002 study directed by Glassman. That investigation included a total of only 369 heart attack patients, too few for the researchers to thoroughly evaluate mortality effects.

“Overall, the data suggest that SSRIs are doing something to increase survival and improve health in depressed heart patients,” Glassman says.

Much remains unknown about this effect, he adds. For instance, it’s unclear how long SSRIs need to be taken to yield cardiac benefits and whether these medications would also boost cardiac health in nondepressed heart attack survivors. Nor do scientists know by what physiological mechanisms depression promotes heart disease and SSRIs quell it.