Patients who'd had a myocardial infarction (MI) coupled with depression didn't have lower rates of morbidity or death after the depression was treated with cognitive behavioral therapy, even though their scores on depression assessments were improved, according to a recent study.

However, a secondary analysis of data from the Enhancing Recovery in Coronary Heart Disease study revealed that within the group of patients who had depression or depression and poor social support (74% of the total post-MI population studied) was a subset of patients who also received antidepressants. In this group, the morbidity and mortality rates were significantly lower; selective serotonin reuptake inhibitors-SSRIs, in particular sertraline (Zoloft)-were associated with fewer adverse cardiovascular events. They may also have some cardioprotective effects.

During an average of almost two and a half years of follow-up, 26% of the patients who didn't take antidepressants (361 of 1388) died, compared with 21.5% of those who did (96 of 446). The study authors write that although their original study wasn't designed to evaluate antidepressant use after MI, "the findings are robust, the sample is large and diverse, and the patients were followed up for a relatively long time" and "clearly demonstrate the need for a properly powered, prospective, randomized trial to determine whether SSRIs can alter cardiovascular outcomes" after MI.

Taylor CB, et al. Arch Gen Psychiatry 2005;62(7):792-8.