Antidepressant Drug Compliance: Reduced Risk of MI and Mortality in Depressed Patients

Selective Serotonin Reuptake Inhibitors, Venlafaxine and Duloxetine are Associated With in Hospital Morbidity but Not Bleeding or Late Mortality After Coronary Artery Bypass Graft Surgery

“…Whether past use of SSRI/SNRI affected the primary endpoints was unknown, although Andreasen et al [14] reported no difference between past and current SSRI use and bleeding, transfusion or early mortality. Similarly, here no information was available concerning depression remission, sustained SSRI use, or even compliance, all factors that may impact survival and incident myocardial infarction rates [44]. The theorised effect of anti-depressants upon cardiac outcome might simply reflect related factors such as sedentary lifestyle, concordance to medication regimes [44], and depression itself.…”

“…Similarly, here no information was available concerning depression remission, sustained SSRI use, or even compliance, all factors that may impact survival and incident myocardial infarction rates [44]. The theorised effect of anti-depressants upon cardiac outcome might simply reflect related factors such as sedentary lifestyle, concordance to medication regimes [44], and depression itself. Likewise, the SSRI/SNRI group was characterised by preponderance to CVD, diabetes, hypertension and female sex, all covariates potentially increasing the risk of morbidity and mortality [19].…”

Management of Depression After Myocardial Infarction

“…Citalopram dose is associated with QTc interval prolongation [40•], and reports of torsades de pointes and sudden cardiac death led the US Food and Drug Administration to require a boxed warning against the use of citalopram doses above 40 mg daily [41]. The increased relative risk is probably low [42,43], and several other studies do not find an association of citalopram with sudden cardiac death [44][45][46].…”

Psychophysiological concepts of stress induced cardiomyopathy with broken heart syndrome as a paradigm

“…For sure, he also needs acute crisis intervention and, depending on the triggering factors, long-term psychotherapeutic care apart from medical interventions. In order to objectively check the balance between the risk of adverse events on the one hand and the risk of depression on the other hand, one must have in mind that antidepressant drugs -irrespectively which class is chosen -improve the outcome and reduce overall mortality of myocardial infarction [46]. It is therefore wise to realistically discuss the issue with the patient or his attorney.…”