מתוך medicontext.co.il
By Megan Rauscher
WESTPORT, CT (Reuters Health) – Preliminary evidence suggests that pharmacologic treatment of depression in MI survivors does lower the risk of subsequent cardiac events, according to Dr. Steven P. Roose.
Dr. Roose, who is director of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York, spoke on the topic of depression and heart disease Thursday at a seminar held at Silver Hill Hospital in New Canaan, Connecticut.
In a telephone interview with Reuters Health, he said that whether treating depression in patients with heart disease and previous MI reduces the risk of subsequent cardiac events and death remains "an open question." However, the chicken-and-egg story of cardiovascular disease and depression should become much clearer when data just now being analyzed from two recently completed studies become available.
Preliminary analyses of one of the studies he referred to, a placebo-controlled trial of antidepressant therapy in post-MI patients with depression, do point to a reduction in cardiac events in sertraline-treated patients. Results from the other study on the effect of psychotherapy in depressed MI patients are expected soon.
"We know that depressed patients die from cardiac disease at a much higher rate than you would expect," he told Reuters Health. But more importantly, he said, mounting evidence indicates that depression earlier in life, before the onset of heart disease, predisposes individuals to cardiovascular or cerebrovascular disease.
"What we are finding is that there is a very complex bi-directional relationship between depression and cardiovascular and cerebrovascular disease," Dr. Roose said. "We think that is because of depression's effect on platelets and other risk factors."
On the other hand, he pointed out, selective serotonin reuptake inhibitors not only treat depression but also have a very strong antiplatelet effect. "They are probably better at reducing platelet clustering than aspirin, so you might reduce cardiac mortality but not by virtue of the fact that you are treating depression, but by virtue of the fact that you are giving a potent anticoagulant in the post-MI period. This has to be sorted out before we rush to treatment."
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