Treating depression after a heart attack

The Family Health Guide

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