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Antidepressants after a heart attack may help prevent further heart problems

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Depression often goes hand-in-hand with acute coronary syndrome - a sudden reduction or blockage of blood flow to the heart. In this randomised clinical trial, Korean researchers investigated the effects of a commonly-used antidepressant, escitalopram, on long-term acute coronary syndrome. From 300 patients with recent acute coronary syndrome and depression, 24-week treatment with escitalopram resulted in fewer major cardiac events than those taking placebo after an eight-year follow-up.

Journal/conference: JAMA

DOI: 10.1001/jama.2018.9422

Organisation/s: Chonnam National University Medical School, Republic of Korea

Funder: National Research Foundation of Korea grant(NRF-2015M3C7A1028899) and supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning( grant NRF-2016R1A2A2A05919518). Dr Stewart is partly funded by the National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. H. Lundbeck A/S provided the study drug

Media Release

From: JAMA

Can Treatment for Depression after a Heart Attack Reduce the Long-Term Risk of Another Cardiac Event? 

Bottom Line: Depression has been associated with poorer medical outcomes for patients with acute coronary syndrome (ACS), including heart attack and unstable angina. This randomized clinical trial of 300 patients in South Korea examined whether antidepressant treatment after ACS improved long-term cardiac outcomes. Patients received either the antidepressant escitalopram or placebo for 24 weeks. After about eight years of follow-up, the antidepressant escitalopram resulted in a lower occurrence of major adverse cardiac events than placebo (40.9 percent vs. 53.6 percent).

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Dr Catherine Crofts, Lecturer, Pharmacology, AUT, and NZ-registered Pharmacist

In the context of this study, I would say this medicine should be considered first line treatment for treating depression following Acute Coronary Syndrome. Escitalopram is a good medicine to use for depression and if it has other cardiovascular benefits, then it is a very reasonable choice. While there appears to be greater benefit to using escitalopram over other antidepressants, to treat depression following an acute coronary even, there is a lot we do not understand.

We cannot explain why this antidepressant (escitalopram) was successful in reducing the risk of a subsequent cardiovascular event.  It does not appear to be a 'class effect' as, in another study, sertraline (another member of the same SSRI class of medicines as escitalopram) showed no benefit in reducing mortality.

This study was conducted in a relatively small group of Korean people who did not have severe cardiovascular disease. We don’t know if these results will apply to Europeans or any other ethnic groups, or to people with severe cardiovascular disease.

Previous research has not shown these benefits when different antidepressant medications have been used. We know that relatively low doses of this medication were effective. This means that the cardiac health benefits may not be related to treating the depression. However, we also know that depression can have negative effects on health, so treating depression can improve a number of health outcomes. There is another study in progress using a citalopram, which is a very similar medication to escitalopram.

Citalopram and escitalopram are very common antidepressants used in New Zealand.  Both of these drugs have a very similar chemical structure. We need more research to better understand what has happened in this study.

Escitalopram should be considered as the first-line treatment in people with depression following acute coronary syndrome. But more research is needed to understand the effects, especially in non-Korean people.

Major and serious adverse effects associated with these medicines are rare. Many people experience transient effects while starting these medicines that may include nausea or insomnia. But your doctor, prescriber, or pharmacist are the best people to talk to about any concerns you have about these medications. These medicines should not be stopped suddenly without medical advice.

Last updated: 24 Jul 2018 12:14pm
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