Antidepressant Use by Class: Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease
| dc.contributor.author | Grace, Sherry | |
| dc.contributor.author | Medina-Inojosa, Jose | |
| dc.contributor.author | Thomas, Randal | |
| dc.contributor.author | Krause, Heather | |
| dc.contributor.author | Vickers-Douglas, Kristin S. | |
| dc.contributor.author | Palmer, Brian | |
| dc.contributor.author | Lopez-Jimenez, Francisco | |
| dc.date.accessioned | 2025-06-11T20:01:46Z | |
| dc.date.available | 2025-06-11T20:01:46Z | |
| dc.date.issued | 2018-03-13 | |
| dc.description | This is the post-peer review, accepted manuscript version of the article available in final form at https://doi.org/10.1159/000486794. | |
| dc.description.abstract | Background: To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. Methods: This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. Results: There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre- (4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37–4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05–2.41) and those on SSRI (HR = 1.45; 95% CI 1.07–1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43–1.82). Conclusion: The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events. | |
| dc.description.sponsorship | This work was supported in part by the European Regional Development Fund-FNUSA-ICRC (No. Z.1.05/1.1.00/02.0123), by project No. LQ1605 from the National Program of Sustainability II (MEYS CR), by the project ICRC-ERA-Human Bridge (No. 316345) funded by the 7th Framework Programme of the European Union, and by resources from the Rochester Epidemiology Project, which is supported by the National Institute on Aging under award No. R01AG034676, a component of the National Institute of Health. | |
| dc.identifier.citation | Grace, S. L., Medina-Inojosa, J. R., Thomas, R. J., Krause, H., Vickers-Douglas, K. S., Palmer, B. A., & Lopez-Jimenez, F. (2018). Antidepressant Use by Class: Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease. Psychotherapy and Psychosomatics, 87(2), 85–94. https://doi.org/10.1159/000486794 | |
| dc.identifier.issn | 1423-0348 | |
| dc.identifier.issn | 0033-3190 | |
| dc.identifier.uri | https://doi.org/10.1159/000486794 | |
| dc.identifier.uri | https://hdl.handle.net/10315/42914 | |
| dc.language.iso | en | |
| dc.publisher | Karger | |
| dc.subject | Depression | |
| dc.subject | Coronary artery disease | |
| dc.subject | Antidepressants | |
| dc.subject | Mortality | |
| dc.subject | Cardiac rehabilitation | |
| dc.title | Antidepressant Use by Class: Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease | |
| dc.type | Article |