Association among Depressive Symptom Changes, Psychopharmacologic Therapy and Outcomes in Cardiac Rehabilitation Participants

Cardiovascular diseases (CVDs) and depression are the leading causes of mortality and disability worldwide, respectively; they are highly comorbid such that depression is 3 times more common in patients after an acute MI than the general population. Depression in patients who have CVD is associated with less adherence to secondary prevention treatments, poor health-related quality of life, and higher rates of adverse events, including mortality rates that are twice as high than those without depression. Patients prescribed antidepressants are often not monitored and screening is controversial, therefore identification and therapeutic response is suboptimal. This thesis is a secondary analysis of post-cardiac rehabilitation patients that explored the intersection of cardiac events and antidepressant use; specifically, the effects of medical history, depression status and antidepressant use on the likelihood of having major adverse cardiac events over a 10 year follow-up period. Antidepressant use was found to have a larger positive effect on depression status vs patients not on antidepressants; most patients were taking an SSRI as per guidelines and the degree of medication adherence was not associated with depressive symptoms. However, TCAs were most often associated with death outcomes, while SSRIs were significantly associated with non-lethal cardiac outcomes. A review of antidepressant use by class in this population may be warranted.