Treating depression after a heart attack
Surviving a heart attack is cause for celebration. It’s also
a trigger for depression. Up to half of heart attack survivors get
the blues, and many go on to develop clinical depression.
Early experiences with antidepressants weren’t that promising
because older tricyclic drugs such as clomipramine and nortriptyline
sometimes threw off heart rhythms and further endangered the heart. This
made doctors leery about recommending antidepressants, even when selective
serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), and
Zoloft (sertraline), and others came along.
However, a small study published in 2002, dubbed SADHART, suggested
that Zoloft could safely treat depression after a heart attack and might
be good for the heart to boot. And an analysis of a larger trial, called
ENRICHD, lends support to the notion that treating post-heart-attack
depression with an SSRI may also reduce the chances of having, or dying
from, a heart attack.
In ENRICHD, antidepressants were prescribed to 450 of the 1,800 participants
who were clinically depressed and didn’t respond to talk therapy.
They were 40% less likely to have died or have a second heart attack
as those who didn’t get medication.
The ENRICHD study isn’t justification for doctors to hand out
Prozac like PEZ. It does reinforces the need for a large, well-designed
trial of SSRIs for post-heart-attack depression. It also highlights the
importance of checking for depression after a heart attack, stroke, diagnosis
of cancer, or other major medical event.
This isn’t high on most doctors’ agendas. If your doctor
doesn’t ask about your mood, tell him or her if you’re feeling
blue, and don’t let the conversation stall there.
January 2006 Update
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