Study: More severe depression after ACS linked with increased death

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Among patients with both major depression and acute coronary syndrome (ACS), those with more severe depression within a few weeks of hospitalization for a cardiac event and those whose depression does not improve within six months appear to have more than double the risk of dying over a seven-year period, according to the SADHART trial in this month’s Archives of General Psychiatry.

About one-fifth of individuals experience major depression in the first few weeks following a heart attack, according to the authors. Depression is associated with an increased risk of death after ACS.

Alexander H. Glassman, MD, of Columbia University Medical Center and New York State Psychiatric Institute in New York City, and colleagues observed participants in a study assessing the safety and effectiveness of antidepressants following heart attack in SADHART (Sertraline Antidepressant Heart Attack Randomized Trial) to establish features of major depression associated with long-term risk of death.

The researchers examined 361 participants who were hospitalized for ACS between 1997 and 1999 and determined to have major depression. Participants were tracked through September 2007.

During a median of 6.7 years of follow-up, 20.9 percent died. The investigators said that the severity of depression during hospitalization for ACS was strongly associated with a significantly increased risk of death.

Regardless of whether they took antidepressants, those whose depression had improved substantially at six months had significantly lower death rates—15.6 percent of patients who were very much or much improved died, compared with 28.4 percent of patients whose depression showed little or no improvement, Glassman and colleagues wrote.

According to the researchers, the risk of death during the study period did not appear to be associated with whether patients had 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. 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,” Glassman and colleagues concluded. “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.”