Antidepressants Fight Heart Disease-Linked Depression

Common drug outperformed psychotherapy in trial

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HealthDay Reporter

TUESDAY, Jan. 23, 2007 (HealthDay News) -- Drug treatment may beat psychotherapy at relieving the major depression felt by many patients with severe heart disease, a Canadian study finds.

The three-month study of 284 people who had already suffered heart attacks or had other problems, such as blockages of cardiac arteries, found treatment with the antidepressant citalopram (Celexa) more effective than weekly psychotherapy sessions at cutting depressive symptoms, according to a report in the Jan. 24/31 issue of the Journal of the American Medical Association.

Celexa is an antidepressant in the family of drugs called selective serotonin reuptake inhibitors (SSRIs), which also includes Paxil, Prozac and Zoloft.

"Several other studies have found that combination treatment of depression in these patients works well," said lead researcher Dr. Francois Lesperance, an associate professor of psychiatry at the University of Montreal. However, "we found that for patients with heart disease, psychotherapy is not superior. It is not bad, but it is not better than drug therapy," he said.

Experts estimate that about 20 percent of people with severe heart disease suffer from major depression. The problem isn't only a mental one: Several studies have indicated that depression can worsen cardiovascular outcomes.

Dr. Alexander H. Glassman is professor of psychiatry at Columbia University College of Physicians and Surgeons, and co-author of an accompanying editorial on the findings. He noted that patients were only included in the study if they were found to have major depression.

"If there is major depression, you should err on the side of treating them," Glassman said. "But mild cases were not included" in the study, so doctors have little guidance in treating less serious depression, he said.

Glassman said his own team reported similar results from a slightly larger study. "The drug [Celexa] really does seem to work" in reducing depression, he said. "The real issue is, does it reduce medical risk? And nobody knows the answer to that. There is a hint that is true from other studies, but medical insurers and the government do not make policy on the basis of hints."

What happens in the real world is that people who have suffered heart attacks or have other major cardiac problems usually are treated by the family physician, who often is not alerted to the danger of depression, Glassman said. "If they don't complain about depression, they don't get treated for depression," he said.

While the evidence for the cardiovascular benefit of such treatment is far from conclusive, treating concurrent depression "is probably better for medical health, at least in a modest way," Glassman said.

Dr. J. Thomas Bigger Jr., a cardiologist who is also professor of medicine at Columbia and a co-author of the editorial, agreed that "it is not clear whether using SSRIs improves the mortality rate or reduces recurrent heart attacks." But he said that there are good reasons to provide these medications to depressed heart patients.

"Depression is painful, a miserable condition, and adding that to a heart attack makes for a very bad situation," Bigger said. "SSRIs work for depression, they are safe in that setting because they cause no problems in cardiovascular disease, and there is no reason not to use them to make the patient feel better. It is like giving aspirin for a headache to make someone feel better."

The safety of SSRIs after a heart attack or similar problem is an important point, because "doctors are a little chary in adding drugs during that time period," Bigger said. "There certainly is no evidence against their safe use in the early period after a heart attack."

More information

Comprehensive information about depression is provided by the U.S. National Institute of Mental Health.

SOURCES: Francois Lesperance, M.D., associate professor, psychiatry, University of Montreal, Canada; Alexander H. Glassman, M.D., professor, psychiatry; and J. Thomas Bigger Jr., M.D., professor, medicine and pharmacology, both of the Columbia University College of Physicians and Surgeons, New York City; Jan. 24/31, 2007, Journal of the American Medical Association

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