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C. Barr Taylor, MD; Marston E. Youngblood, MA, MPH; Diane Catellier, DrPH; Richard C. Veith, MD; Robert M. Carney, PhD; Matthew M. Burg, PhD; Peter G. Kaufmann, PhD; John Shuster, MD, MPH; Thomas Mellman, MD; James A. Blumenthal, PhD; Ranga Krishnan, MB, ChB; Allan S. Jaffe, MD; for the ENRICHD Investigators

Arch Gen Psychiatry. 2005;62:792-798.

Background  Depression after myocardial infarction (MI) is associated with higher morbidity and mortality. Although antidepressants are effective in reducing depression, their use in patients with cardiovascular disease remains controversial.

Objective  To undertake a secondary analysis to determine the effects of using antidepressants on morbidity and mortality in post-MI patients who participated in the Enhancing Recovery in Coronary Heart Disease study.

Design  Observational secondary analysis.

Setting  Eight academic sites.

Patients  The Enhancing Recovery in Coronary Heart Disease clinical trial randomized 2481 depressed and/or socially isolated patients from October 1, 1996, to October 31, 1999. Depression was diagnosed using a structured clinical interview. This analysis was conducted on the 1834 patients enrolled with depression (849 women and 985 men).

Intervention  Use of antidepressant medication.

Main Outcome Measures  Event-free survival was defined as the absence of death or recurrent MI. All-cause mortality was also examined. To relate exposure to antidepressants to subsequent morbidity and mortality, the data were analyzed using a time-dependent covariate model.

Results  During a mean follow-up of 29 months, 457 fatal and nonfatal cardiovascular events occurred. The risk of death or recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors (adjusted hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.38-0.84), as were the risk of all-cause mortality (adjusted HR, 0.59; 95% CI, 0.37-0.96) and recurrent MI (adjusted HR, 0.53; 95% CI, 0.32-0.90), compared with patients who did not use selective serotonin reuptake inhibitors. For patients taking non–selective serotonin reuptake inhibitor antidepressants, the comparable HRs (95% CIs) were 0.72 (0.44-1.18), 0.64 (0.34-1.22), and 0.73 (0.38-1.38) for risk of death or recurrent MI, all-cause mortality, or recurrent MI, respectively, compared with nonusers.

Conclusions  Use of selective serotonin reuptake inhibitors in depressed patients who experience an acute MI might reduce subsequent cardiovascular morbidity and mortality. A controlled trial is needed to examine this important issue.

Author Affiliations: Department of Psychiatry and Behavioral Sciences, Stanford Medical Center, Stanford University School of Medicine, Stanford, Calif (Dr Taylor); Department of Biostatistics, The University of North Carolina at Chapel Hill (Mr Youngblood and Dr Catellier); Department of Psychiatry, University of Washington, Seattle (Dr Veith); Department of Psychiatry and Behavioral Sciences, Washington University, St Louis, Mo (Dr Carney); Department of Psychiatry, Yale University, New Haven, Conn (Dr Burg); National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Kaufmann); Department of Psychiatry, The University of Alabama at Birmingham (Dr Shuster); Department of Psychiatry, Dartmouth Medical School, Hanover, NH (Dr Mellman); Department of Psychiatry, Duke University, Durham, NC (Drs Blumenthal and Krishnan); and Department of Cardiology and Internal Medicine, Mayo Clinic, Rochester, Minn (Dr Jaffe).
Group Information: A list of the members of the ENRICHD Investigators appears in JAMA (2003;289:3115).

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