Antidepressants may pose risk to heart patients

By Karla Gale

NEW YORK (Reuters Health) – Patients with coronary artery
disease may be at increased risk of death while using
antidepressant drugs, according to the results of an
observational study reported at the American Psychosomatic
Society in Denver.

However, “people with heart disease should definitely not
stop taking their antidepressants, because we do not know if
antidepressants were causing this (increased risk) or if it was
due to some other characteristics of folks who are on
antidepressants,” presenter Dr. Lana L. Watkins told Reuters
Health.

Their study evaluated “the contribution of anxiety and
depression to the risk of sudden cardiac death in patients with
coronary artery disease,” the researcher noted.

Watkins and her colleagues at Duke University in Durham,
North Carolina, monitored depressive symptoms and
antidepressant use among 921 patients ages 29 to 90 years who
were hospitalized for coronary angiography, a procedure used to
diagnose heart disease. “All of the patients had a history of
or current coronary artery disease,” she said.

Antidepressants were being used by 19.4 percent of
subjects. Two thirds of the antidepressants were selective
serotonin reuptake inhibitors, a relatively new class of
antidepressants that include drugs such as Prozac.

During an average of three years of follow-up, 21.4 percent
of the patients taking antidepressants died, compared with 12.5
percent of those not on antidepressants. After adjusting for
demographic factors, cardiac risk factors, scores on the Beck
Depression Inventory test, and the presence of other illness,
antidepressant use was an independent risk factor for
mortality, increasing the risk by 62 percent.

“It’s possible that patients taking antidepressants had
other factors” (that could account for the increased risk), so
the finding could just be incidental, Watkins emphasized.

For example, people on antidepressants may be sicker or
more depressed, she explained, which in turn could lead to
suppression of the immune system or an increase in
cardiovascular risk factors such as high blood pressure,
physical inactivity or alcohol or tobacco abuse.

“That is why it would be very premature for patients to
stop taking their medications.”

She does however advise physicians to closely monitor their
patients with coronary artery disease who are taking
antidepressants. Meanwhile, she and her associates are planning
a more rigorous trial to more closely examine the factors
contributing to mortality risk in patients with coronary heart
disease.