Depression Following a Coronary Event Increases Risk of Death

Patients who suffer from depression in the first several weeks after being hospitalized for a coronary event and those patients whose depression does not improve over six months are at an increased risk of death compared to coronary patients who are not depressed.

Writing in the September issue of Archives of General Psychiatry, lead author Alexander Glassman, MD, Columbia University Medical Center and New York State Psychiatric Institute, and colleagues describe their findings that, after 6.7 years of follow-up, 75 participants, or 20.9%, had died, and, among those who had died, depression during hospitalization “was strongly associated with a significantly increased risk of death.” Patients whose depression had improved significantly within six months had a much lower death rate of death, at 15.6%, compared to patients whose depression had only improved slightly or not at all (28.4%). Study results were reached regardless of whether or not patients had taken antidepressants.

According to the journal abstract, the Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) compared the “safety and antidepressant efficacy” of sertraline compared to a placebo in 369 patients with acute coronary syndrome who met the criteria for major depression disorder. The researchers add that a patient’s risk of death during the study did seem to be correlated with previous episodes of depression, whether their depression developed before or after their cardiac event, or whether they took antidepressants during the first six months following hospitalization.”

"Depression is a syndrome with multiple pathways to a similar clinical picture,” the researchers said. “In patients with active coronary heart disease, it seems likely that the association with depression is a two-way street, and each can aggravate the other. Because persistent depression increases mortality and decreases medication adherence, physicians need to aggressively treat depression and be diligent in promoting adherence to guideline cardiovascular drug therapy."

J. Thomas Bigger Jr, MD, of the department of medicine at Columbia’s College of Physicians and Surgeons, and Michael Gaffney, PhD, of Pfizer, also served as authors of the study.