Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: A randomized controlled trial

• Published in: Journal of psychosomatic research 2013-01, Vol.74 (1), p.25-30
• Main Authors: Zuidersma, Marij, Conradi, Henk Jan, van Melle, Joost P, Ormel, Johan, de Jonge, Peter
• Format: Article
• Language: English
• Subjects: Aged; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Cardiovascular prognosis; Citalopram - adverse effects; Citalopram - therapeutic use; Depression treatment; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Mianserin - adverse effects; Mianserin - analogs & derivatives; Mianserin - therapeutic use; Middle Aged; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - psychology; Patient Readmission - statistics & numerical data; Personality Inventory - statistics & numerical data; Psychiatry; Psychometrics; Psychotherapy; Risk; Secondary Prevention; Survival Rate
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2012.08.015

Abstract Objective Evaluating the effects of implementing an antidepressant treatment strategy in depressed myocardial infarction (MI)-patients on long-term cardiovascular outcomes and all-cause mortality. Methods MI-patients were evaluated for the presence of a diagnosis of post-MI depression at 3, 6, 9 and 12 months after hospitalization for MI. A total of 331 depressed MI-patients were randomized to intervention or care-as-usual (CAU). Patients randomized to the intervention were offered several antidepressant treatment options including pharmacological and non-pharmacological therapy. Patients randomized to CAU were not given feedback about their depression status. All patients were free to seek depression treatment outside the study, which was monitored. The primary outcome was a combined endpoint of cardiovascular events and cardiac mortality between randomization and 8 years later. All-cause mortality was evaluated as secondary endpoint. Results The intervention did not reduce the risk of the primary outcome (HR: 0.97 (95% CI: 0.67–1.40) n = 330) or all-cause mortality (HR: 0.74 (95% CI: 0.41–1.33) n = 330). Regardless of randomization status, patients who received depression treatment ( n = 168) had reduced all-cause mortality rates compared to those who did not receive treatment ( n = 143, HR: 0.52 (95% CI: 0.28–0.97)). Conclusion Implementing an antidepressant treatment strategy did not reduce the risk of cardiovascular morbidity and mortality compared to usual care. Receiving depression treatment increased survival. It remains unclear whether this represents a direct treatment effect or is due to unmeasured factors that relate to both receiving depression treatment and mortality, such as patients' intrinsic motivation to care for their health.