Harvard Heart Letter

Heart Beat: Antidepressant little help in heart failure

Depression is a common traveler with heart failure. Symptoms of heart failure, like fatigue and breathlessness, contribute to depression. Activation of stress hormones by a failing heart play a part, as does living with a chronic condition. Back in 2002, results of a trial called SADHART showed that the antidepressant sertraline (Zoloft) was a safe and effective treatment for major depression after a heart attack. Hoping to extend that work, researchers tested a 12-week course of sertraline in 469 men and women with heart failure. The drug was safe — meaning it didn't worsen heart failure or cause cardiovascular problems — but it didn't ease depression any better than placebo (Journal of the American College of Cardiology, August 24, 2010).

If you have heart failure and depression, palliative care specialist Dr. Sarah J. Goodlin offers these suggestions in an editorial accompanying the report:

  • Make sure you and your doctor are aggressively treating your heart failure.

  • Be tested for sleep-related breathing problems like sleep apnea. Get treatment if needed.

  • Start or continue an exercise program.

  • Get education, counseling, or support about coping with heart failure.

  • Consider drug therapy for depression — see a specialist for this if necessary. Possible cardiovascular side effects don't rule out the use of antidepressants in people with heart failure, but mean they must be used with extra caution.

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