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Zoloft May Be Safe to Fight Depression After Heart Attack

Study finds antidepressant reduced serious side effects by 23 percent

TUESDAY, Aug. 13, 2002 (HealthDayNews) -- Almost 20 percent of heart attack victims fall into clinical depression -- something that not only makes them feel rotten but also worsens their prognosis.

However, doctors haven't always treated the condition, partly because cardiologists don't recognize it or, if they do, most believe antidepressants have dangerous side effects.

Now, a new study shows that a drug in a relatively new family of antidepressants can be used safely and effectively. A trial of 369 patients with either heart attacks or life-endangering unstable angina found that antidepressant treatment gives definite medical improvement with no significant side effects.

The antidepressant is sertraline, marketed as Zoloft, a member of the SSRI (selective serotonin reuptake inhibitor) family. The incidence of major adverse events, such as death or readmission to a hospital, was reduced by 23 percent in patients diagnosed with depression who got sertraline rather than a placebo, says a report in tomorrow's Journal of the American Medical Association.

Most of the money for the study came from Pfizer Inc., the company that sells Zoloft, acknowledges study author Dr. Alexander H. Glassman, a professor of psychiatry at the Columbia College of Physicians and Surgeons. However, he adds that was because government money wasn't available.

"This was an investigator-initiated study," Glassman says. "I started trying to do it in 1993. I tried to get money from the National Heart, Lung, and Blood Institute, but they had just funded a very large study of psychotherapy for depression after a heart attack."

Whatever the source of the money, the study, while preliminary, gives "a strong suggestion that drug treatment can reduce mortality," Glassman says.

"What becomes clearer because of this study is that you can reduce morbidity and mortality by treating depression," he says. The 23 percent reduction in adverse events "was bigger than we anticipated," Glassman says. "We never thought we would get that kind of reduction."

Robert M. Carney, a professor of psychiatry at Washington University School of Medicine and co-author of an editorial accompanying the study, still cautions against jumping to conclusions.

"It is important to recognize the limitations of this study," he says. The study included a relatively small number of patients and did not run long enough to give evidence that antidepressant treatment actually saves lives, Carney adds.

"But I am very pleased that the study was done, and that it turned out the way it did," he says. "I hope it encourages more and larger studies. The next step should be another, larger clinical trial that would detect the effect of treatment on the medical outcome."

Will other SSRIs such as Paxil and Prozac give the same beneficial result?

"We have tested Zoloft, and we know what it does," Glassman says. "Other SSRIs are similar, but until they are tested we don't really know."

Nevertheless, he has a strong suspicion that other SSRIs will help heart patients because of the way they act in the body. Specifically, an SSRI has the same effect as aspirin on the platelets that can form clots and block arteries, he says.

It's important for doctors treating cardiac patients to diagnose depression, Glassman adds. Each of the 40 medical centers in his study had both a cardiologist and a psychiatrist assess each patient. That is impractical for most hospitals, so he says doctors treating such patients "have to pay more attention to it, and if the condition is not clear, then get a psychiatrist in on it."

What To Do

To learn about depression, consult the National Foundation for Depressive Illness.

This article from the National Institute of Mental Health explains the emotional effects of a heart attack.

SOURCES: Alexander H. Glassman M.D., professor, psychiatry, Columbia College of Physicians and Surgeons, New York City; Robert M. Carney, Ph.D, professor, psychiatry, Washington University School of Medicine, St. Louis; Aug. 14, 2002, Journal of the American Medical Association
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