The Incidence, Clinical Significance, and Treatment Effects of Depression in Cardiac Resynchronization Therapy Recipients

Abstract

Objectives: Chronic heart failure (HF) is associated with significantly increased prevalence of depression. The aim of the study was to assess the incidence and clinical impact of depression as well as the effectiveness of depression treatment in HF patients. Methods: A prospective interventional trial included 285 consecutive cardiac resynchronization therapy recipients. Patients underwent a psychiatric examination at the time of implantation and then it was routinely repeated at 3, 6, and 12 months after the procedure, and every 6 months thereafter. One hundred and thirty-five (47.4%) patients with depression were included in the depression group, whereas the control group was comprised of 150 patients free of depression. Sixty-eight (50.4%) subjects received antidepressants (treated group), whereas the observational group had 67 (49.6%) depressed patients who refused to take antidepressants. Results: Depression remission was achieved in 51 (75.0%) patients from the treated group. Long-term mortality and HF hospitalization rates were significantly higher in the depression group than in the control group (20.7 vs. 11.3% and 32.6 vs. 19.2%, respectively). However, remission from depression was associated with a 40% reduction in the relative risk of major adverse cardiac events (MACE). Conclusions: Patients with HF and concomitant depression are at higher risk of MACE compared with those free of depression. Effective antidepressant treatment may significantly improve long-term outcomes in this population.

The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review

“…Depression remission rates were significantly higher at 6-month and 12-month follow-up time points in the treatment versus no treatment group ( p <0.001). 31 In a small study ( n =21) by Roose et al on one group of nortriptyline patients followed prospectively, depression severity decreased significantly pre- to post-intervention ( p <0.001). 32 …”

“…Podolecki et al found that for those patients who achieved remission from depression in the escitalopram treatment group, they had significantly less major adverse cardiac events at long-term follow-up as compared to untreated patients ( p <0.05). 31 The Roose et al ( n =21) study found that nortriptyline treatment (titrated to 50–150 ng/mL) did not significantly change ejection fraction pre to post treatment ( p >0.05). 32 In another small study ( n =36), Roose et al followed a group of patients prospectively who received treatment with bupropion (150–450 mg).…”

“…Escitalopram treatment was found to have no effect on all-cause mortality in one study and decreased in another ( p =0.003), and yet another study found a decrease in cardiac events ( p <0.05). 16 , 13 , 31 Treatment with buproprion showed significant reduction in premature depolarizations ( p <0.005). 35 Inflammatory markers were less in patients taking SNRI/TCA than those using SSRIs ( p <0.001) or no depression ( p =0.001).…”

“…The study designs included five RCTs, two prospective studies, one cross-sectional study, one pilot study, and one open-label study. Pharmacological agents and the range of doses that were used in studies assessing depressive symptom severity include sertraline (50 mg), 26 , 27 sertraline (50–200 mg), 28 citalopram (20–40 mg), 15 nefazodone (50–600 mg), 29 paroxetine controlled release (12.5–25 mg), 30 escitalopram (10–20 mg), 16 , 31 nortriptyline titrated to therapeutic level of 50 to 150 ng/mL, 32 and one study that used multiple classes of antidepressants (selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs], norepinephrine and dopamine reuptake inhibitors [NDRIs], serotonin and norepinephrine reuptake inhibitors [SNRIs]) of unknown dosage. 33 …”

Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

“…A recent survey indicated that almost half of patients felt insufficiently informed about technical aspects or had worries about aspects of their implantable devices 187 . A considerable number of heart failure patients suffer from depressive symptoms, which are associated with worse outcomes 188 . Psychosocial concerns and worries should be addressed in a multidisciplinary approach.…”