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Antidepressants, autonomic function and mortality in patients with coronary heart disease: data from the Heart and
F Zimmermann-Viehoff1, L K Kuehl1, H Danker-Hopfe1
1Department of Psychiatry and Psychotherapy,Charité University Medical School Berlin,Campus Benjamin Franklin, Berlin,Germany.
Insights
Tricyclic antidepressants (TCA) are linked to higher mortality in coronary heart disease patients, potentially due to impaired autonomic function. Selective serotonin reuptake inhibitors (SSRI) showed no such association, suggesting TCAs should be avoided.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Antidepressants are used for depressive symptoms in coronary heart disease (CHD) patients.
- Concerns exist regarding increased mortality associated with antidepressant use in this population.
Purpose of the Study:
- To investigate the association between tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI) use and mortality in CHD patients.
- To determine if autonomic function mediates this association.
Main Methods:
- A cohort of 956 CHD patients was followed for a mean of 7.2 years.
- Autonomic function was assessed using heart rate variability and norepinephrine levels.
Main Results:
- TCA users had lower heart rate variability and higher norepinephrine at baseline.
- TCA use was associated with a 74% increased risk of mortality (HR 1.74).
- Adjustment for autonomic function markers reduced this association, while SSRI use was not linked to mortality.
Conclusions:
- Tricyclic antidepressant use is associated with increased mortality in coronary heart disease patients.
- Autonomic dysfunction partially mediates this increased mortality risk.
- Tricyclic antidepressants should be used with caution or avoided in patients with coronary heart disease.
Background:
Antidepressants reduce depressive symptoms in patients with coronary heart disease, but they may be associated with increased mortality. This study aimed to examine whether the use of tricyclic antidepressants (TCA) or selective serotonin reuptake inhibitors (SSRI) is associated with mortality in patients with coronary heart disease, and to determine whether this association is mediated by autonomic function.
Method:
A total of 956 patients with coronary heart disease were followed for a mean duration of 7.2 years. Autonomic function was assessed as heart rate variability, and plasma and 24-h urinary norepinephrine.
Results:
Of 956 patients, 44 (4.6%) used TCA, 89 (9.3%) used SSRI, and 823 (86.1%) did not use antidepressants. At baseline, TCA users exhibited lower heart rate variability and higher norepinephrine levels compared with SSRI users and antidepressant non-users. At the end of the observational period, 52.3% of the TCA users had died compared with 38.2% in the SSRI group and 37.3% in the control group. The adjusted hazard ratio (HR) for TCA use compared with non-use was 1.74 [95% confidence interval (CI) 1.12-2.69, p = 0.01]. Further adjustment for measures of autonomic function reduced the association between TCA use and mortality (HR = 1.27, 95% CI 0.67-2.43, p = 0.47). SSRI use was not associated with mortality (HR = 1.15, 95% CI 0.81-1.64, p = 0.44).
Conclusions:
The use of TCA was associated with increased mortality. This association was at least partially mediated by differences in autonomic function. Our findings suggest that TCA should be avoided in patients with coronary heart disease.
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