Antidepressants Effective, Safe for Patients After Heart Attacks

Antidepressants effectively treat depression in patients who have a history of heart attacks without adversely impacting their long-term prognosis, according to a study issued in BMC Psychiatry. Additionally, antidepressants were linked to a decreased risk of heart attack recurrence.

“Meta-analyses indicate that post–[heart attack] depression is associated with a 1.6- to 2.7-fold increased risk of mortality and cardiovascular events during long-term follow-up, highlighting the critical need for effective interventions,” wrote Hongquan Wan and colleagues at The First Hospital of Jilin University in Changchun, China.

Wan and colleagues conducted a meta-analysis of 12 studies assessing antidepressants as a post–heart attack depression intervention; the studies included more than 15,000 patients and had follow-up periods that ranged from six months to more than eight years. Depression severity was measured by validated tools such as the Beck Depression Inventory and the Hamilton Depression Rating Scale.

Though baseline depression scores did not differ between the control and treatment groups, antidepressant treatment significantly reduced depression scores at long-term follow-up. Antidepressants did not increase the risk of adverse cardiac events, all-cause mortality, or rehospitalization for heart disease.

Antidepressant treatment was associated with about a 21% reduced risk of heart attack recurrence and a 14% reduced risk of needing coronary stents. However, the researchers noted that these potential benefits should be interpreted cautiously given that a large observational study found the opposite outcome.

Depression after heart attacks “is an established independent risk factor for poor cardiac prognosis,” the authors wrote. “While some reports have raised concerns about the potential cardiac risks of antidepressants, the overall evidence suggests that they are safe and effective when appropriately prescribed.”

For related information, see the Psychiatric News article “Antidepressants May Lower Heart Attack Risk in Diabetes.”

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High Blood Glucose, Triglycerides Linked to Long-Term Risk of Mental Disorders

Individuals with elevated blood levels of glucose and triglycerides have an increased risk of depression, anxiety, and stress-related disorders, as do individuals with low blood levels of HDL cholesterol (“good cholesterol”), a study in JAMA Network Open has found. Further, elevated levels of glucose or triglycerides were present in individuals who developed one of these disorders as far back as 20 years prior to diagnosis.

Charilaos Chourpiliadis, M.D., of the Karolinska Institutet in Stockholm and colleagues analyzed data from 211,200 participants in the Apolipoprotein-Related Mortality Risk cohort who underwent occupational health screening between January 1, 1985, and December 31, 1996. As part of the screening, blood tests were done to measure glucose, total cholesterol, HDL cholesterol, LDL cholesterol (“bad cholesterol”), triglycerides and other markers of metabolic and cardiovascular risk. The researchers determined clinical cutoffs for these blood markers based on previous research and/or cardiovascular disease guidelines.

Study participants had a mean age of 42.1 years at their first screening and were followed for a mean of 21 years. The researchers examined the individuals’ diagnoses in the Swedish Patient Register to look for a first diagnosis of depression, anxiety, or stress-related disorders. They defined stress-related disorders as acute stress reaction, posttraumatic stress disorder, adjustment disorders, other reactions to severe stress, and unspecified reaction to severe stress.

Over the follow-up period, 16,256 individuals were diagnosed with depression, anxiety, or stress-related disorders, with a mean age at diagnosis of 60.5 years. The researchers found the following:

• Individuals with blood glucose levels of 110 mg/deciliter or higher had a 30% higher risk of depression, anxiety, and stress-related disorders compared to those with lower levels.
• Individuals with triglyceride levels of 150 mg/deciliter or higher had a 15% higher risk of these mental illnesses compared to those with lower levels.
• Individuals with HDL cholesterol levels of 40 mg/deciliter or higher had a 12% lower risk of these mental illnesses compared to those with lower levels.

“These results add further evidence of the association between cardiometabolic health and psychiatric disorders and potentially advocate for a closer follow-up of individuals with metabolic dysregulations for prevention and early diagnosis of psychiatric disorders,” the researchers wrote. “Additional studies are needed to explore whether rigorous or earlier interventions for cardiometabolic diseases could counteract such an association.”

For related information, see the American Journal of Psychiatry article “Genetic and Environmental Contribution to the Co-Occurrence of Endocrine-Metabolic Disorders and Depression: A Nationwide Swedish Study of Siblings.”

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