Non-response to antidepressants raises cardiac risk

Patients showing no response to antidepressant treatment, after suffering a heart attack and subsequently developing depression, might have a high risk of another cardiac event. Researchers from the University Medical Center Groningen, the Netherlands, analysed the data obtained from the Myocardial Infarction and Depression-Intervention Trial (MIND-IT). This involved 2,177 patients who were hospitalised with an acute heart attack. During follow-up, 375 patients developed post-heart-attack depression. Out of these, 209 patients were randomly assigned to receive mirtazapine, sold under the trade name Remeron, or to usual care methods. If there was an inadequate response to mirtazapine after eight weeks, the patients were switched to citalopram, sold under the trade name Celexa. It was found that the recurrent cardiac event rate was about 26 per cent among depressed patients who did not respond to treatment, 11 per cent among those who received care as usual and a little more than seven per cent among patients who responded to antidepressant treatment. After the researchers adjusted the data for other risk factors that could contribute to the patients' outcome, the non-responders were nearly three times more likely to experience a new cardiovascular event compared with the untreated usual care patients. These findings provide additional preliminary evidence that patients who do not respond to treatment for post-heart attack depression have an increased risk of another cardiovascular episode. The results also show that depression that develops after a heart attack may have a direct role in a patient's cardiovascular prognosis. However, the priority always is to alter the course of the patients who face additional cardiovascular risk with more effective treatments.