Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction

C. Barr Taylor, Marston E. Youngblood, Diane Catellier, Richard C. Veith, Robert M. Carney, Matthew M. Burg, Peter G. Kaufmann, John Shuster, Thomas Mellman, James A. Blumenthal, Ranga Krishnan, Allan S Jaffe

Research output: Contribution to journalArticle

407 Citations (Scopus)

Abstract

Background: Depression after myocardial infarction (MI) is associated with higher morbidity and mortality. Although antidepressants are effective in reducing depression, their use in patients with cardiovascular disease remains controversial. Objective: To undertake a secondary analysis to determine the effects of using antidepressants on morbidity and mortality in post-MI patients who participated in the Enhancing Recovery in Coronary Heart Disease study. Design: Observational secondary analysis. Setting: Eight academic sites. Patients: The Enhancing Recovery in Coronary Heart Disease clinical trial randomized 2481 depressed and/or socially isolated patients from October 1, 1996, to October 31, 1999. Depression was diagnosed using a structured clinical interview. This analysis was conducted on the 1834 patients enrolled with depression (849 women and 985 men). Intervention: Use of antidepressant medication. Main Outcome Measures: Event-free survival was defined as the absence of death or recurrent MI. All-cause mortality was also examined. To relate exposure to antidepressants to subsequent morbidity and mortality, the data were analyzed using a time-dependent covariate model. Results: During a mean follow-up of 29 months, 457 fatal and nonfatal cardiovascular events occurred. The risk of death or recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors (adjusted hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.38-0.84), as were the risk of all-cause mortality (adjusted HR, 0.59; 95% CI, 0.37-0.96) and recurrent MI (adjusted HR, 0.53; 95% CI, 0.32-0.90), compared with patients who did not use selective serotonin reuptake inhibitors. For patients taking non-selective serotonin reuptake inhibitor antidepressants, the comparable HRs (95% CIs) were 0.72 (0.44-1.18), 0.64 (0.34-1.22), and 0.73 (0.38-1.38) for risk of death or recurrent MI, all-cause mortality, or recurrent MI, respectively, compared with nonusers. Conclusions: Use of selective serotonin reuptake inhibitors in depressed patients who experience an acute MI might reduce subsequent cardiovascular morbidity and mortality. A controlled trial is needed to examine this important issue.

Original languageEnglish (US)
Pages (from-to)792-798
Number of pages7
JournalArchives of General Psychiatry
Volume62
Issue number7
DOIs
StatePublished - Jul 2005

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Antidepressive Agents
Myocardial Infarction
Morbidity
Mortality
Serotonin Uptake Inhibitors
Confidence Intervals
Coronary Disease
Disease-Free Survival
Cardiovascular Diseases
Randomized Controlled Trials
Outcome Assessment (Health Care)
Interviews

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. / Taylor, C. Barr; Youngblood, Marston E.; Catellier, Diane; Veith, Richard C.; Carney, Robert M.; Burg, Matthew M.; Kaufmann, Peter G.; Shuster, John; Mellman, Thomas; Blumenthal, James A.; Krishnan, Ranga; Jaffe, Allan S.

In: Archives of General Psychiatry, Vol. 62, No. 7, 07.2005, p. 792-798.

Research output: Contribution to journalArticle

Taylor, CB, Youngblood, ME, Catellier, D, Veith, RC, Carney, RM, Burg, MM, Kaufmann, PG, Shuster, J, Mellman, T, Blumenthal, JA, Krishnan, R & Jaffe, AS 2005, 'Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction', Archives of General Psychiatry, vol. 62, no. 7, pp. 792-798. https://doi.org/10.1001/archpsyc.62.7.792
Taylor, C. Barr ; Youngblood, Marston E. ; Catellier, Diane ; Veith, Richard C. ; Carney, Robert M. ; Burg, Matthew M. ; Kaufmann, Peter G. ; Shuster, John ; Mellman, Thomas ; Blumenthal, James A. ; Krishnan, Ranga ; Jaffe, Allan S. / Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. In: Archives of General Psychiatry. 2005 ; Vol. 62, No. 7. pp. 792-798.
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abstract = "Background: Depression after myocardial infarction (MI) is associated with higher morbidity and mortality. Although antidepressants are effective in reducing depression, their use in patients with cardiovascular disease remains controversial. Objective: To undertake a secondary analysis to determine the effects of using antidepressants on morbidity and mortality in post-MI patients who participated in the Enhancing Recovery in Coronary Heart Disease study. Design: Observational secondary analysis. Setting: Eight academic sites. Patients: The Enhancing Recovery in Coronary Heart Disease clinical trial randomized 2481 depressed and/or socially isolated patients from October 1, 1996, to October 31, 1999. Depression was diagnosed using a structured clinical interview. This analysis was conducted on the 1834 patients enrolled with depression (849 women and 985 men). Intervention: Use of antidepressant medication. Main Outcome Measures: Event-free survival was defined as the absence of death or recurrent MI. All-cause mortality was also examined. To relate exposure to antidepressants to subsequent morbidity and mortality, the data were analyzed using a time-dependent covariate model. Results: During a mean follow-up of 29 months, 457 fatal and nonfatal cardiovascular events occurred. The risk of death or recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors (adjusted hazard ratio [HR], 0.57; 95{\%} confidence interval [CI], 0.38-0.84), as were the risk of all-cause mortality (adjusted HR, 0.59; 95{\%} CI, 0.37-0.96) and recurrent MI (adjusted HR, 0.53; 95{\%} CI, 0.32-0.90), compared with patients who did not use selective serotonin reuptake inhibitors. For patients taking non-selective serotonin reuptake inhibitor antidepressants, the comparable HRs (95{\%} CIs) were 0.72 (0.44-1.18), 0.64 (0.34-1.22), and 0.73 (0.38-1.38) for risk of death or recurrent MI, all-cause mortality, or recurrent MI, respectively, compared with nonusers. Conclusions: Use of selective serotonin reuptake inhibitors in depressed patients who experience an acute MI might reduce subsequent cardiovascular morbidity and mortality. A controlled trial is needed to examine this important issue.",
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AU - Carney, Robert M.

AU - Burg, Matthew M.

AU - Kaufmann, Peter G.

AU - Shuster, John

AU - Mellman, Thomas

AU - Blumenthal, James A.

AU - Krishnan, Ranga

AU - Jaffe, Allan S

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N2 - Background: Depression after myocardial infarction (MI) is associated with higher morbidity and mortality. Although antidepressants are effective in reducing depression, their use in patients with cardiovascular disease remains controversial. Objective: To undertake a secondary analysis to determine the effects of using antidepressants on morbidity and mortality in post-MI patients who participated in the Enhancing Recovery in Coronary Heart Disease study. Design: Observational secondary analysis. Setting: Eight academic sites. Patients: The Enhancing Recovery in Coronary Heart Disease clinical trial randomized 2481 depressed and/or socially isolated patients from October 1, 1996, to October 31, 1999. Depression was diagnosed using a structured clinical interview. This analysis was conducted on the 1834 patients enrolled with depression (849 women and 985 men). Intervention: Use of antidepressant medication. Main Outcome Measures: Event-free survival was defined as the absence of death or recurrent MI. All-cause mortality was also examined. To relate exposure to antidepressants to subsequent morbidity and mortality, the data were analyzed using a time-dependent covariate model. Results: During a mean follow-up of 29 months, 457 fatal and nonfatal cardiovascular events occurred. The risk of death or recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors (adjusted hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.38-0.84), as were the risk of all-cause mortality (adjusted HR, 0.59; 95% CI, 0.37-0.96) and recurrent MI (adjusted HR, 0.53; 95% CI, 0.32-0.90), compared with patients who did not use selective serotonin reuptake inhibitors. For patients taking non-selective serotonin reuptake inhibitor antidepressants, the comparable HRs (95% CIs) were 0.72 (0.44-1.18), 0.64 (0.34-1.22), and 0.73 (0.38-1.38) for risk of death or recurrent MI, all-cause mortality, or recurrent MI, respectively, compared with nonusers. Conclusions: Use of selective serotonin reuptake inhibitors in depressed patients who experience an acute MI might reduce subsequent cardiovascular morbidity and mortality. A controlled trial is needed to examine this important issue.

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