Meta-analysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease

Am J Cardiol. 2011 Apr 1;107(7):972-9. doi: 10.1016/j.amjcard.2010.11.017. Epub 2011 Jan 20.

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 to evaluate 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 in MEDLINE, EMBASE, PsycINFO, Cochrane Controlled Clinical Trial Register and other trial registries, and references of relevant articles. Primary outcomes were readmission for CHD (including myocardial infarction, unstable angina, and stroke) and all-cause mortality; the secondary outcome was severity of depression symptoms. Seven articles on 6 RCTs involving 2,461 participants were included. One study incorrectly randomized participants, and another was a reanalysis of RCT 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% confidence interval 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 associated with a significant decrease in CHD readmission (0.63, 0.46 to 0.86) and mortality rates (0.56, 0.35 to 0.88). A significantly greater improvement in depression symptoms was always apparent in patients on SSRIs with all selected indicators. In conclusion, in patients with CHD and depression, SSRI medication decreases depression symptoms and may improve CHD prognosis.

Publication types

  • Meta-Analysis

MeSH terms

  • Aged
  • Antidepressive Agents, Second-Generation / adverse effects
  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Cause of Death
  • Coronary Disease / drug therapy*
  • Coronary Disease / mortality
  • Coronary Disease / psychology*
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / mortality
  • Depressive Disorder / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Treatment Outcome

Substances

  • Antidepressive Agents, Second-Generation
  • Serotonin Uptake Inhibitors