Treating Depression Can Prevent a Repeated Heart Attack

TUESDAY, July 24, 2018 (HealthDay News) – It is common for heart attack survivors to develop a depression. A new trial showed that antidepressant treatment could help these patients avoid a second heart attack.

The study of 300 cardiac patients with depression showed that treatment with the antidepressant escitalopram (Lexapro) reduced by almost half the risk of suffering from another attack over the next eight years.

Patients receiving the drug also had a lower mortality rate and had less need for angioplasty – a procedure that opens blocked cardiac arteries.

The experts said they were encouraged by the results. "This is a very important clinical trial," said James Blumenthal, professor of psychiatry at Duke University Medical Center, in Durham, NC

Blumenthal, who did not participate in the trial, studying the role of psychological factors in heart disease

He said that it was known that patients with heart attack suffering from depression were generally treated worse than those who did not suffer from it. This includes a higher risk of a repeated heart attack.

But the evidence has been lacking that treatment of depression can result in better prospects.

The new discoveries, says Blumenthal, show that he can do it. This not only results in improved quality of life, but also improves clinical outcomes, "he said. For the trial, Korean researchers led by Dr. Jae-Min Kim, of Chonnam National University Medical School in Gwangju, examined more than 1,100 heart patients for depression. All patients had had an "acute coronary syndrome" in the past two weeks. The term refers to heart attacks, as well as unstable angina – severe chest pain caused by clogged blood flow to the heart.

More than 400 of these patients met the definition of mild or major depression. Eventually, 300 patients entered the trial and were randomly assigned to take escitalopram tablets or placebo for six months

Over the next eight years, almost half of the patients were died, had a new heart attack or needed angioplasty. However, the rate was lower in patients taking antidepressants: just under 41%, compared to almost 54% in placebo patients

. The benefit was clearer when it was have another heart attack: less than 9% of the antidepressants patients did, compared to more than 15 percent of placebo patients, the results showed.

The mortality rate was also lower for those taking antidepressants – about 21 percent, compared to 24.5 percent for those taking a placebo. However, this difference was not significant in statistical terms

The lawsuit was funded by grants from the Korean government. The report was published in the July 1945 issue of the Journal of the American Medical Association .

If antidepressant treatment counteracts future heart problems, we do not know why, according to Blumenthal. 19659002] One possibility, he suggested, is that when patients see their depression lift, they become more physically active or better able to stick to lifestyle changes.

But, improvement in depression could also have direct effects – including less inflammation in

Donald Edmondson is director of the Center for Behavioral Cardiovascular Health at Columbia University, in New York.

He described the results as "exciting and important".

Why does this trial show benefits when previous studies have been shown to be empty? A likely reason, Edmondson said, is long-term follow-up. It may take years before the benefits of treating depression begin to manifest themselves.

Patients and families should never ignore persistent psychological symptoms, he says.

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But nearly 40 percent of the initial group of this study found positive to depression. "It's common," he said.

Edmondson suggested that family members be aware of this, and do not forget to check: "Ask questions, ask them how they feel."

There are non-drug treatments for depression, including "verbal therapy." This trial did not test them – but Edmondson said that he suspects any therapy that sends depression into remission could improve the patients' cardiac outlook.

In this study, he pointed out that patients whose depression was in remission – even though they were in the placebo group.

Patients on medication were, however, more likely to see remission: more than half, compared to 35 percent of patients on placebo.

Blumenthal says that some research has shown that exercise can help relieve depression – and can be as effective as antidepressants.

He is currently leading an essay to evaluate the effect of escitalopram on the treatment of anxiety in patients with heart disease.

[19659002] The American Heart Association has more about heart disease and depression.