A Heart-Felt Difference: Drug Therapy is Seen to Boost Survival Rates Better Than Counseling in Cardiac Patients Who Suffer From Depression

By Jamie Talan, Newsday, Melville, N.Y.

Jan. 24–Treating depression in those who have suffered heart attacks is safe and effective — and may be ultimately be good for the heart itself, according to a new study by a team of Canadian doctors.

Dr. Francois Lesperance at the University of Montreal and his Canadian colleagues compared the benefits of the antidepressant Celexa against 12 weeks of psychotherapy and standard aftercare. They recruited 284 patients with coronary heart disease and depression and found that the drug worked and psychotherapy didn’t.

The Canadian group showed that depressive symptoms were reduced more in heart patients taking Celexa compared with the other regimens.

The latest findings are published in the Journal of the American Medical Association.

This is the third large study that set out to answer the question of whether the depression that appears to occur more frequently in heart patients should be aggressively treated with drugs.

It may seem intuitive that someone with depression should be treated, but some doctors have seen symptoms of depression in heart attack patients as an “understandable reaction to stress” that will resolve on its own, Dr. Alexander Glassman and Dr. J. Thomas Bigger wrote in the editorial accompanying the Canadian study.

The work began in the early 1990s when the Canadian group found that depressed heart disease patients are three times more likely to die in the first six months after the initial cardiac event. The next logical question was whether treating depression reduces this risk.

Older antidepressants actually increased the risk of cardiac complications, and doctors had been worried about their use, especially in the elderly.

The two other studies suggested that treating depression may prevent a recurrence of heart attack or death, but more work needs to be done, experts say. Glassman, chief of psychopharmacology at Columbia University College of Physicians and Surgeons in Manhattan and an expert on depression and heart disease, said, “We clearly need a large federally funded trial to see whether treating depression is good for the heart. The studies that have been done suggest that we should treat depressed heart patients — it would be unethical to do otherwise.”

The first big study in the 1990s was done to find out whether antidepressant treatment is safe and effective. It was conducted on patients within weeks of the heart attack or unstable angina. This latest study recruited people up to 18 months after the cardiac event.

The other major study, also in the 1990s, sponsored by the federal government, involved 1,850 patients; half were given psychotherapy and half received standard care by their own doctors. The therapy reduced symptoms of depression somewhat but showed no effect on the mortality rate.

After eight weeks of the six-month therapy, those who were still severely depressed were offered an antidepressant. Thirty months later, when the researchers analyzed this group of medicated patients and compared them with unmedicated depressed patients, they found a 40 percent reduction in death or heart attack.

But this study was not done by medical doctors, who wanted to verify this apparently remarkable reduction.

In the initial multicenter trial, dubbed SADHART, 369 patients were followed for six months. Researchers found a 23 percent reduction in life-threatening events for those taking antidepressants. But Glassman, who was part of the study, said it would take several thousand patients to prove that it was having a direct impact on heart health and mortality.

The psychiatrist said no one is sure why antidepressants may have this effect. One explanation is that people with depression are less likely to take care of themselves and follow doctor’s orders. There also could be something in the drug itself that interacts with the heart to prevent further damage.

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Copyright (c) 2007, Newsday, Melville, N.Y.

Distributed by McClatchy-Tribune Business News.

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