Worrying Your Way to a Heart Attack?

Heart attack patients have better survival rates when they medically treat their depression

(RxWiki News) People with depressive symptoms have an increased risk of heart attacks and developing heart disease. For those who already have heart problems, stress and depression can worsen their health.

A recent study found that depressed patients who had recently had a heart attack had better survival rates after receiving treatment intervention for their depression.

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Marij Zuidersma, PhD, of the Department of Psychiatry at University Medical Center Groningen in the Netherlands, and colleagues led the study to see if heart attack patients with depression would have better long-term outcomes if their depression were treated.

A total of 331 depressed patients that had recently had heart attacks were enrolled in the study. Depression was measured using the Beck Depression Inventory. This is a widely used test. Patients took the test during hospitalization and every three months for a year. The depression treatment intervention lasted six months.

The study participants were randomly assigned to two groups. The first group was offered different options of depression treatment. Treatments included placebo versus mirtazapine, an antidepressant medication. A second treatment offered was treatment with citalopram, another antidepressant. The third was a "tailored treatment" designed by the psychiatrist.

All participants in this group were offered monthly sessions with the psychiatrist. They also got feedback about their depression levels. The second group was not offered any treatment but they could seek it on their own. If they did seek it, they were asked to reported it.

There were two outcomes that were measured. The first was if the participant had any cardiac-related hospitalizations or death. The second outcome measured was all-cause death rate. All-cause means all deaths as the result of a medical condition.

The researchers found that the depression intervention treatment did not reduce the risk of future negative cardiac events, cardiac death or death by all-causes.

What they did find is that patients who received depression treatment had reduced all-cause death rates compared to those that did not receive treatment. For those who had treatment, 168 patients had better a survival rate, compared to 143 that did not have any treatment.

"It remains unclear whether this represents a direct treatment effect or is due to unmeasured factors that relate to both receiving depression treatment and mortality, such as patients' intrinsic motivation to care for their health," authors commented in the study on better survival rates after receiving treatment.

The authors noted some limitations with the study. The participants were recruited 10 years ago and there have been many medical advances since then. Therefore the findings may not apply to the current population. The study had a lower than expected study power, which caused issues with their statistical analysis. Also, the researchers were only able to collect depression data in 66 percent of participants and they did not measure the type or intensity of the depression treatment. Because of this, depression and its effect on cardiac events and death could not be measured.

The study, "Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: A randomized controlled trial," was published by the Journal of Psychosomatic Research. It was funded by the Dutch Medical Research Council, Netherlands Heart Foundation, Organon (The Netherlands) and Lundbeck (Denmark). Dr. Marij Zuidersma, of Department of Psychiatry, University Medical Center Groningen, The Netherlands, and co-authors noted no conflict of interest in the study.