Antidepressant link to cardiac event 

Among patients who have had a heart attack and subsequently develop depression, a lack of response to antidepressant treatment signals a high risk of another cardiac episode, according to a secondary analysis of data from Myocardial Infarction and Depression-Intervention Trial.

The trial involved 2,177 patients who were hospitalized with an acute heart attack.

During follow-up, 375 patients developed post-heart attack depression.

209 of these patients were randomly assigned to receive mirtazapine, sold under the trade name Remeron, or to "care as usual."

If there was an inadequate response to mirtazapine after 8 weeks, the patients were switched to citalopram, sold under the trade name Celexa, according to the report in the American Journal of Psychiatry.

Dr Peter de Jonge of the University Medical Center Groningen, the Netherlands, and colleagues report that the recurrent cardiac event rate was 25.6% among depressed patients who did not respond to treatment; 11.2% among those who received care as usual; and 7.4% among patients who responded to antidepressant treatment.

After the researchers adjusted the data for other risk factors that could contribute to the patients' outcome, the nonresponders were nearly three times more likely to experience a new cardiovascular event compared with the untreated "usual care" patients.

These findings provide additional preliminary evidence that patients who don't response to treatment for post-heart attack depression have an increased risk of another cardiovascular episode, the investigators conclude.

The results also leave open the possibility that depression that develops after a heart attack may have a direct role in a patient's cardiovascular prognosis, de Jonge and colleagues add.

However, right now the priority is to alter the course of the patients who face additional cardiovascular risk with more effective treatments.

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