Abstract
Background and ObjectivesDepression is common among acute coronary syndrome (ACS) patients and is associated with poor prognosis. Cardiac side effects of older antidepressants were well-known, but newer antidepressants are generally thought of as safe to use in patients with heart disease. The objective was to assess rates of antidepressant use or prescription to patients within a year of an ACS.MethodsPubMed, PsycINFO, and CINAHL databases searched through May 29, 2009; manual searching of 33 journals from May 2009 to September 2010. Articles in any language were included if they reported point or period prevalence of antidepressant use or prescription in the 12 months prior or subsequent to an ACS for ≥100 patients. Two investigators independently selected studies for inclusion/exclusion and extracted methodological characteristics and outcomes from included studies (study setting, inclusion/exclusion criteria, sample size, prevalence of antidepressant prescription/use, method of assessing antidepressant prescription/use, time period of assessment).ResultsA total of 24 articles were included. The majority were from North America and Europe, and most utilized chart review or self-report to assess antidepressant use or prescription. Although there was substantial heterogeneity in results, overall, rates of antidepressant use or prescription increased from less than 5% prior to 1995 to 10–15% after 2000. In general, studies from North America reported substantially higher rates than studies from Europe, approximately 5% higher among studies that used chart or self-report data.ConclusionsAntidepressant use or prescription has increased considerably, and by 2005 approximately 10% to 15% of ACS patients were prescribed or using one of these drugs.
Highlights
Major depressive disorder (MDD) is present in approximately 20% of patients with coronary heart disease (CHD), including acute coronary syndrome (ACS) patients [1,2]
The potential for tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) to cause serious and potentially fatal side effects has limited their use in cardiac populations [7,8]
Studies with inclusion criteria that required antidepressant use or a condition associated with antidepressant use and studies that utilized antidepressants as part of an intervention were excluded unless they reported data on antidepressant prescription or use for all patients assessed for study eligibility
Summary
Major depressive disorder (MDD) is present in approximately 20% of patients with coronary heart disease (CHD), including acute coronary syndrome (ACS) patients [1,2]. The rate of self-reported antidepressant use increased from approximately 7% to 12% among US adults from 1996 to 2005. Selective serotonin reuptake inhibitors (SSRIs) have generally been accepted as safe in cardiac patients because they appear to lack these side effects [9,10,11]. Depression is common among acute coronary syndrome (ACS) patients and is associated with poor prognosis. Cardiac side effects of older antidepressants were well-known, but newer antidepressants are generally thought of as safe to use in patients with heart disease.
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