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Treating Depression in Patients with Ischaemic Heart Disease

Which Agents are Best to Use and to Avoid?

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Abstract

There are a number of dimensions to the complex relationship between cardiovascular disease and affective disorders including: (i) patients with depression are at an increased risk of dying from sudden cardiovascular death compared with the general population; (ii) patients with depression over the course of a lifetime have a higher rate of symptomatic and fatal ischaemic heart disease compared with a control group without depression; and, (iii) patients after either a myocardial or a cerebrovascular infarction who are depressed have a higher mortality rate than their medically comparable nondepressed counterparts.

The deleterious impact of depression on the prognosis of cardiac disease and the suggestion that treatment of depression may reduce cardiac mortality has led clinicians to seek safe and effective treatment for patients with comorbid depression and ischaemic disease.

Though they are robustly effective, the tricyclic antidepressants are type 1A antiarrhythmic agents and presumably carry the same risk in patients with ischaemic disease as treatment with other type 1 antiarrhythmics such as moricizine. Short term studies of the safety of other antidepressant agents, specifically amfebutamone (bupropion) and the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) fluoxetine, paroxetine and sertraline, suggest that these medications have a benign cardiovascular profile in patients with depression and pre-existing cardiac disease. However, given the methodological limitations of study design and the relatively small number of patients included, it is premature to conclude that SSRIs are a ‘safe’ treatment in patients with heart disease.

Thus, clinicians must still make treatment decisions on a case by case basis, considering the type and severity of depression and cardiovascular disease, as well as what is known about the cardiovascular effects and therapeutic profile of the different classes of antidepressant medications.

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References

  1. Malzberg B. Mortality among patients with involution melancholia. Am J Psychiatry 1937; 93: 1231–8

    Google Scholar 

  2. Black DW, Warrack G, Winokur G. The Iowa record-linkage study: III: excess mortality among patients with ‘functional’ disorders. Arch Gen Psychiatry 1985; 42: 82–8

    Article  PubMed  CAS  Google Scholar 

  3. Weeke A. Causes of death in manic-depressives. In: Schou M, Stromgren E, editors. Origin, prevention and treatment of affective disorders. London: Academic Press, 1979: 289–99

    Google Scholar 

  4. Glassman AH, Heizer JE, Covey LS, et al. Smoking, smoking cessation, and major depression. JAMA 1990; 264: 1546–9

    Article  PubMed  CAS  Google Scholar 

  5. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease. Am J Psychiatry 1998; 155: 411

    Google Scholar 

  6. Carney RM, Rich MW, Freedland KE, et al. Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom Med 1988; 50: 627–33

    PubMed  CAS  Google Scholar 

  7. Schleifer SJ, Macari-Hinson MM, Coyle DA, et al. The nature and course of depression following myocardial infarction. Arch Intern Med 1989; 149: 1785–9

    Article  PubMed  CAS  Google Scholar 

  8. Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction: impact on 6-month survival. JAMA 1993; 270: 1819–25

    Article  PubMed  CAS  Google Scholar 

  9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980

    Google Scholar 

  10. Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91: 999–1005

    Article  PubMed  CAS  Google Scholar 

  11. Avery D, Winokur G. Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatry 1976; 33: 1029–37

    Article  PubMed  CAS  Google Scholar 

  12. Roose SP, Glassman AH. Cardiovascular effects of tricyclic antidepressants in depressed patients with and without heart disease [abstract]. J Clin Psychiatry 1989; 50 Suppl.: 118

    Google Scholar 

  13. Glassman AH, Roose SP, Bigger JT, Jr. The safety of tricyclic antidepressants in cardiac patients: risk/benefit reconsidered. JAMA 1993; 269: 2673–5

    Article  PubMed  CAS  Google Scholar 

  14. Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989; 321: 406–12

    Article  Google Scholar 

  15. Cardiac Arrhythmia Suppression Trial II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 1992; 327: 227–33

    Article  Google Scholar 

  16. Falk RH. Flecainide-induced ventricular tachycardia and fibrillation in patients treated for atrial fibrillation. Ann Intern Med 1989; 111: 107–11

    PubMed  CAS  Google Scholar 

  17. Coplen SE, Antman EM, Berlin JA, et al. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion: a meta-analysis of randomized control trials. Circulation 1990; 82: 1106–16

    Article  PubMed  CAS  Google Scholar 

  18. Greenberg HM, Dwyer EM, Jr., Hochman JS, et al. Interaction of ischaemia and encainide/flecainide treatment: a proposed mechanism for the increased mortality in CAST I. Br Heart J 1995; 74: 631–5

    Article  PubMed  CAS  Google Scholar 

  19. Roose SP, Dalack GW, Glassman AH, et al. Cardiovascular effects of bupropion in depressed patients with heart disease. Am J Psychiatry 1991; 148: 512–6

    PubMed  CAS  Google Scholar 

  20. Roose SP, Glassman AH, Attia E, et al. Cardiovascular effects of fluoxetine in depressed patients with heart disease. Am J Psychiatry 1998; 155(5): 660–5

    PubMed  CAS  Google Scholar 

  21. Roose SP, Laghrissi-Thode F, Kennedy JS, et al. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. JAMA 1998; 279: 287–91

    Article  PubMed  CAS  Google Scholar 

  22. Hamilton MA. Rating for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62

    Article  PubMed  CAS  Google Scholar 

  23. Shapiro PA, Glassman AH, Lesperance F, et al. Treatment of major depression after acute myocardial infarction with sertraline: a preliminary study. Proceedings of the American Psychiatric Association: New York: New Research, 1996: 249–50

    Google Scholar 

  24. Roose SP, Glassman AH, Attia E, et al. Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia. Am J Psychiatry 1994; 151: 1735–9

    PubMed  CAS  Google Scholar 

  25. Zielinski, RJ, Roose SP, Devanand DP, et al. Cardiovascular complications of ECT in depressed patients with cardiac disease. Am J Psychiatry 1993; 150: 904–9

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. College of Physicians and Surgeons, Columbia University, 722 West 168th Street, New York, New York, 10032, USA

    Steven P. Roose

  2. Late Life Depression Research Clinic, New York State Psychiatric Institute, New York, New York, USA

    Erica Spatz

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  1. Steven P. Roose
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  2. Erica Spatz
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Correspondence to Steven P. Roose.

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Roose, S.P., Spatz, E. Treating Depression in Patients with Ischaemic Heart Disease. Drug-Safety 20, 459–465 (1999). https://doi.org/10.2165/00002018-199920050-00006

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