Treating depression seen important in heart failure

NEW YORK (Reuters Health) - Depression increases the risk of death in patients with heart failure, but the risk apparently disappears with antidepressant use, according to a study.

"Recent studies suggest that the use of antidepressants may be associated with increased mortality (death) in patients with cardiac disease," Dr. Christopher M. O'Connor, of Duke University Medical Center, Durham, North Carolina, and colleagues note in the medical journal Archives of Internal Medicine.

"Because depression has also been shown to be associated with increased mortality in these patients, it remains unclear if this association is attributable to the use of antidepressants or to depression."

The researchers therefore studied roughly 1,000 patients hospitalized for heart failure who were followed up annually. The authors prospectively collected data on depression status and use of antidepressants.

Roughly 16 percent of the study subjects were taking some form of antidepressant during the initial hospital stay. Overall, 30 percent were considered depressed and 24.5 percent of them were taking antidepressants. The team also found that 12.5 percent of non-depressed patients were taking antidepressants.

Over an average of about 971 days, 429 patients, or roughly 43 percent, died. An initial analysis that did not factor out potentially confounding variables showed that use of antidepressants was associated with a 32 percent increased risk of dying.

However, "multivariate analysis" controlling for depression and other potentially confounding factors showed that antidepressant use was not associated with poor survival, but depression per se was.

This finding, the researchers say, supports the need for randomized clinical trials that are adequately powered to evaluate whether antidepressant medication may reduce mortality and other heart-related outcomes without raising safety concerns among depressed heart patients.

"The ongoing National Institute of Mental Health-funded Sertraline Antidepressant Heart Attack Randomized Trial-Chronic Heart Failure, a randomized double-blind placebo-controlled study of SSRI therapy in depressed patients with HF, is likely to provide further insight into this issue," they note.

SOURCE: Archives of Internal Medicine, November 10, 2008.