The occurrence of depression in patients with coronary heart disease (CHD)substantially increases the likelihood of a poorer cardiovascular prognosis.Although antidepressants are generally effective in decreasing depression, their use in patients with CHD is controversial. We carried out a meta-analysis toevaluate the health effects of selective serotonin reuptake inhibitors (SSRIs)versus placebo or no antidepressants in patients with CHD and depression.Observational studies and randomized controlled trials (RCTs) were searched inMEDLINE, EMBASE, PsycINFO, Cochrane Controlled Clinical Trial Register and other trial registries, and references of relevant articles. Primary outcomes werereadmission for CHD (including myocardial infarction, unstable angina, andstroke) and all-cause mortality; the secondary outcome was severity of depressionsymptoms. Seven articles on 6 RCTs involving 2,461 participants were included.One study incorrectly randomized participants, and another was a reanalysis ofRCT data. These were considered observational and analyzed separately. When only properly randomized trials were considered (n = 734 patients), patients on SSRIs showed no significant differences in mortality (risk ratio 0.39, 95% confidenceinterval 0.08 to 2.01) or CHD readmission rates (0.74, 0.44 to 1.23) compared to controls. Conversely, when all studies were included, SSRI use was associatedwith a significant decrease in CHD readmission (0.63, 0.46 to 0.86) and mortalityrates (0.56, 0.35 to 0.88). A significantly greater improvement in depressionsymptoms was always apparent in patients on SSRIs with all selected indicators.In conclusion, in patients with CHD and depression, SSRI medication decreasesdepression symptoms and may improve CHD prognosis.
Meta-analysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease
Rutjes A;
2011-01-01
Abstract
The occurrence of depression in patients with coronary heart disease (CHD)substantially increases the likelihood of a poorer cardiovascular prognosis.Although antidepressants are generally effective in decreasing depression, their use in patients with CHD is controversial. We carried out a meta-analysis toevaluate the health effects of selective serotonin reuptake inhibitors (SSRIs)versus placebo or no antidepressants in patients with CHD and depression.Observational studies and randomized controlled trials (RCTs) were searched inMEDLINE, EMBASE, PsycINFO, Cochrane Controlled Clinical Trial Register and other trial registries, and references of relevant articles. Primary outcomes werereadmission for CHD (including myocardial infarction, unstable angina, andstroke) and all-cause mortality; the secondary outcome was severity of depressionsymptoms. Seven articles on 6 RCTs involving 2,461 participants were included.One study incorrectly randomized participants, and another was a reanalysis ofRCT data. These were considered observational and analyzed separately. When only properly randomized trials were considered (n = 734 patients), patients on SSRIs showed no significant differences in mortality (risk ratio 0.39, 95% confidenceinterval 0.08 to 2.01) or CHD readmission rates (0.74, 0.44 to 1.23) compared to controls. Conversely, when all studies were included, SSRI use was associatedwith a significant decrease in CHD readmission (0.63, 0.46 to 0.86) and mortalityrates (0.56, 0.35 to 0.88). A significantly greater improvement in depressionsymptoms was always apparent in patients on SSRIs with all selected indicators.In conclusion, in patients with CHD and depression, SSRI medication decreasesdepression symptoms and may improve CHD prognosis.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
