This research letter describes the results of a prospective cohort study that sought to evaluate the association between use of selective serotonin reuptake inhibitors (SSRIs) or non-SSRI second generation antidepressants and cardiac events in patients with coronary heart disease.
The cohort sample included 432 patients hospitalised with acute coronary syndrome (ACS), who completed the Beck Depression Inventory and a diagnostic depression interview. They were split into three groups according to use of antidepressants at admission or discharge (assessed by self-report and medical review): patients not receiving any antidepressant (n=354), patients receiving SSRIs only (n=58), and patients receiving non-SSRI second-generation antidepressants only (n=20) [patients receiving other antidepressant classes were excluded due to their low numbers].
Over a median follow-up of 40 months, the rates of major adverse cardiovascular events (MACEs) or mortality were 36.2% among users of SSRIs, 20.0% among users of non-SSRI second-generation antidepressants, and 21.5% among patients not receiving any antidepressant. After controlling for demographics, medical covariates, and depression severity, SSRI use carried an increased risk for first MACE or mortality compared with no antidepressant use (adjusted hazard ratio [HR] 1.83; 95% CI 1.09-3.06; P=0.02). There was no such association seen for non-SSRI second-generation antidepressant use. The increased hazard of MACE and/or mortality for SSRI users compared with non-SSRI second-generation antidepressant users was not statistically significant (HR 1.99; 95% CI 0.68-5.81; P=0.21).
Those patients who initiated antidepressants during the hospital stay appeared to be at an increased risk for first MACE or mortality compared to non-users, whereas patients who continued to use SSRIs that had been prescribed prior to the ACS did not appear to be at an increased risk.
The study had a number of limitations, including the post hoc nature of the analyses, the limited power for analysis of the effects of non-SSRI second-generation antidepressants due to the small number of users, and the fact that there was no reliable information on the dose of antidepressants or the length of time they were taken prior to or after the ACS. The authors call for further research comparing the safety and efficacy of SSRIs and non-SSRI second-generation antidepressants.