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Antidepressants, autonomic function and mortality in patients with coronary heart disease: data from the Heart and Soul Study

Published online by Cambridge University Press:  25 March 2014

F. Zimmermann-Viehoff ,
L. K. Kuehl ,
H. Danker-Hopfe ,
M. A. Whooley  and
C. Otte
F. Zimmermann-Viehoff
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
L. K. Kuehl
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
H. Danker-Hopfe
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
M. A. Whooley
Affiliation:
VA Medical Center, San Francisco, CA, USA University of California, Department of Medicine and of Epidemiology and Biostatistics, San Francisco, CA, USA
C. Otte*
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
*
*Address for correspondence: C. Otte, M.D., Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Eschenallee 3, 14050 Berlin, Germany. (Email: [email protected])
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Abstract

Background

Antidepressants reduce depressive symptoms in patients with coronary heart disease, but they may be associated with increased mortality. This study aimed to examine whether the use of tricyclic antidepressants (TCA) or selective serotonin reuptake inhibitors (SSRI) is associated with mortality in patients with coronary heart disease, and to determine whether this association is mediated by autonomic function.

Method

A total of 956 patients with coronary heart disease were followed for a mean duration of 7.2 years. Autonomic function was assessed as heart rate variability, and plasma and 24-h urinary norepinephrine.

Results

Of 956 patients, 44 (4.6%) used TCA, 89 (9.3%) used SSRI, and 823 (86.1%) did not use antidepressants. At baseline, TCA users exhibited lower heart rate variability and higher norepinephrine levels compared with SSRI users and antidepressant non-users. At the end of the observational period, 52.3% of the TCA users had died compared with 38.2% in the SSRI group and 37.3% in the control group. The adjusted hazard ratio (HR) for TCA use compared with non-use was 1.74 [95% confidence interval (CI) 1.12–2.69, p = 0.01]. Further adjustment for measures of autonomic function reduced the association between TCA use and mortality (HR = 1.27, 95% CI 0.67–2.43, p = 0.47). SSRI use was not associated with mortality (HR = 1.15, 95% CI 0.81–1.64, p = 0.44).

Conclusions

The use of TCA was associated with increased mortality. This association was at least partially mediated by differences in autonomic function. Our findings suggest that TCA should be avoided in patients with coronary heart disease.

Keywords

Coronary heart diseaseheart rate variabilitymortalitynorepinephrineselective serotonin reuptake inhibitorstricyclic antidepressants
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 14 , October 2014 , pp. 2975 - 2984
Copyright
Copyright © Cambridge University Press 2014 

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References

Allen, R, Fisher, J, Kop, W, Plumhoff, J (2011). Depression and cardiovascular disease: diagnosis, predictive value, biobehavioral mechanisms, and intervenions. In Heart and Mind (ed. Allen, R. and Fisher, J.), pp. 143–168. American Psychological Association: Washington, DC.Google Scholar
Anand, IS, Fisher, LD, Chiang, YT, Latini, R, Masson, S, Maggioni, AP, Glazer, RD, Tognoni, G, Cohn, JN (2003). Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 107, 1278–1283.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. American Psychological Association: Washington, DC.Google Scholar
Baumeister, H, Hutter, N, Bengel, J (2011). Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD008012. doi:10.1002/14651858.CD008012.pub3.Google Scholar
Benedict, CR, Shelton, B, Johnstone, DE, Francis, G, Greenberg, B, Konstam, M, Probstfield, JL, Yusuf, S (1996). Prognostic significance of plasma norepinephrine in patients with asymptomatic left ventricular dysfunction. SOLVD Investigators. Circulation 94, 690–697.Google Scholar
Blumenthal, JA, Sherwood, A, Babyak, MA, Watkins, LL, Smith, PJ, Hoffman, BM, O'Hayer, CV, Mabe, S, Johnson, J, Doraiswamy, PM, Jiang, W, Schocken, DD, Hinderliter, AL (2012). Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study. Journal of the American College of Cardiology 60, 1053–1063.Google Scholar
Cohen, HW, Gibson, G, Alderman, MH (2000). Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. American Journal of Medicine 108, 2–8.Google Scholar
Czarny, MJ, Arthurs, E, Coffie, DF, Smith, C, Steele, RJ, Ziegelstein, RC, Thombs, BD (2011). Prevalence of antidepressant prescription or use in patients with acute coronary syndrome: a systematic review. PLoS ONE 6, e27671.Google Scholar
Fosbøl, EL, Gislason, GH, Poulsen, HE, Hansen, ML, Folke, F, Schramm, TK, Olesen, JB, Bretler, DM, Abildstrøm, SZ, Sørensen, R, Hvelplund, A, Køber, L, Torp-Pedersen, C (2009). Prognosis in heart failure and the value of β-blockers are altered by the use of antidepressants and depend on the type of antidepressants used. Circulation. Heart Failure 2, 582–590.Google Scholar
Gehi, A, Mangano, D, Pipkin, S, Browner, WS, Whooley, MA (2005). Depression and heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Archives of General Psychiatry 62, 661–666.Google Scholar
Gehi, AK, Ali, S, Na, B, Whooley, MA (2007). Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study. Archives of Internal Medicine 167, 1798–1803.Google Scholar
Glassman, AH, Bigger, JT, Gaffney, M, Van Zyl, LT (2007). Heart rate variability in acute coronary syndrome patients with major depression: influence of sertraline and mood improvement. Archives of General Psychiatry 64, 1025–1031.Google Scholar
Glassman, AH, O'Connor, CM, Califf, RM, Swedberg, K, Schwartz, P, Bigger, JT Jr, Krishnan, KR, van Zyl, LT, Swenson, JR, Finkel, MS, Landau, C, Shapiro, PA, Pepine, CJ, Mardekian, J, Harrison, WM, Barton, D, McLvor, M; Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) Group (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. Journal of the American Medical Association 288, 701–709.Google Scholar
Hamer, M, Batty, GD, Seldenrijk, A, Kivimaki, M (2011). Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. European Heart Journal 32, 437–442.Google Scholar
Honkola, J, Hookana, E, Malinen, S, Kaikkonen, KS, Junttila, MJ, Isohanni, M, Kortelainen, ML, Huikuri, HV (2012). Psychotropic medications and the risk of sudden cardiac death during an acute coronary event. European Heart Journal 33, 745–751.Google Scholar
Janszky, I, Ericson, M, Mittleman, MA, Wamala, S, Al-Khalili, F, Schenck-Gustafsson, K, Orth-Gomer, K (2004). Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease: the Stockholm Female Coronary Risk Study. Journal of Internal Medicine 255, 13–21.Google Scholar
Kemp, AH, Quintana, DS, Gray, MA, Felmingham, KL, Brown, K, Gatt, JM (2010). Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biological Psychiatry 67, 1067–1074.Google Scholar
Kennedy, BP, Rao, F, Botiglieri, T, Sharma, S, Lillie, EO, Ziegler, MG, O'Connor, DT (2005). Contributions of the sympathetic nervous system, glutathione, body mass and gender to blood pressure increase with normal aging: influence of heredity. Journal of Human Hypertension 19, 951–969.Google Scholar
Krantz, DS, Whittaker, KS, Francis, JL, Rutledge, T, Johnson, BD, Barrow, G, McClure, C, Sheps, DS, York, K, Cornell, C, Bittner, V, Vaccarino, V, Eteiba, W, Parashar, S, Vido, DA, Merz, CN (2009). Psychotropic medication use and risk of adverse cardiovascular events in women with suspected coronary artery disease: outcomes from the Women's Ischemia Syndrome Evaluation (WISE) study. Heart 95, 1901–1906.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.Google Scholar
Lesperance, F, Frasure-Smith, N, Koszycki, D, Laliberte, MA, van Zyl, LT, Baker, B, Swenson, JR, Ghatavi, K, Abramson, BL, Dorian, P, Guertin, MC (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of the American Medical Association 297, 367–379.Google Scholar
Licht, CM, de Geus, EJ, van Dyck, R, Penninx, BW (2010). Longitudinal evidence for unfavorable effects of antidepressants on heart rate variability. Biological Psychiatry 68, 861–868.Google Scholar
Licht, CM, de Geus, EJ, Zitman, FG, Hoogendijk, WJ, van Dyck, R, Penninx, BW (2008). Association between major depressive disorder and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA). Archives of General Psychiatry 65, 1358–1367.Google Scholar
Licht, CM, Penninx, BW, de Geus, EJ (2012). Effects of antidepressants, but not psychopathology, on cardiac sympathetic control: a longitudinal study. Neuropsychopharmacology 37, 2487–2495.Google Scholar
Mann, DL, Kent, RL, Parsons, B, Cooper, G 4th (1992). Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 85, 790–804.Google Scholar
McManus, D, Pipkin, SS, Whooley, MA (2005). Screening for depression in patients with coronary heart disease (data from the Heart and Soul Study). American Journal of Cardiology 96, 1076–1081.Google Scholar
Meredith, IT, Broughton, A, Jennings, GL, Esler, MD (1991). Evidence of a selective increase in cardiac sympathetic activity in patients with sustained ventricular arrhythmias. New England Journal of Medicine 325, 618–624.Google Scholar
Nicholson, A, Kuper, H, Hemingway, H (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal 27, 2763–2774.Google Scholar
O'Connor, CM, Jiang, W, Kuchibhatla, M, Mehta, RH, Clary, GL, Cuffe, MS, Christopher, EJ, Alexander, JD, Califf, RM, Krishnan, RR (2008). Antidepressant use, depression, and survival in patients with heart failure. Archives of Internal Medicine 168, 2232–2237.Google Scholar
O'Connor, CM, Jiang, W, Kuchibhatla, M, Silva, SG, Cuffe, MS, Callwood, DD, Zakhary, B, Stough, WG, Arias, RM, Rivelli, SK, Krishnan, R (2010). Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. Journal of the American College of Cardiology 56, 692–699.Google Scholar
Odemuyiwa, O, Malik, M, Farrell, T, Bashir, Y, Poloniecki, J, Camm, J (1991). Comparison of the predictive characteristics of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events and sudden death after acute myocardial infarction. American Journal of Cardiology 68, 434–439.Google Scholar
Otte, C, Neylan, TC, Pipkin, SS, Browner, WS, Whooley, MA (2005). Depressive symptoms and 24-hour urinary norepinephrine excretion levels in patients with coronary disease: findings from the Heart and Soul Study. American Journal of Psychiatry 162, 2139–2145.Google Scholar
Ray, WA, Meredith, S, Thapa, PB, Hall, K, Murray, KT (2004). Cyclic antidepressants and the risk of sudden cardiac death. Clinical Pharmacology and Therapeutics 75, 234–241.Google Scholar
Ruo, B, Rumsfeld, JS, Hlatky, MA, Liu, H, Browner, WS, Whooley, MA (2003). Depressive symptoms and health-related quality of life: the Heart and Soul Study. Journal of the American Medical Association 290, 215–221.Google Scholar
Sauer, WH, Berlin, JA, Kimmel, SE (2001). Selective serotonin reuptake inhibitors and myocardial infarction. Circulation 104, 1894–1898.Google Scholar
Sauer, WH, Berlin, JA, Kimmel, SE (2003). Effect of antidepressants and their relative affinity for the serotonin transporter on the risk of myocardial infarction. Circulation 108, 32–36.Google Scholar
Schlienger, RG, Fischer, LM, Jick, H, Meier, CR (2004). Current use of selective serotonin reuptake inhibitors and risk of acute myocardial infarction. Drug Safety 27, 1157–1165.Google Scholar
Sherwood, A, Blumenthal, JA, Trivedi, R, Johnson, KS, O'Connor, CM, Adams, KF Jr, Dupree, CS, Waugh, RA, Bensimhon, DR, Gaulden, L, Christenson, RH, Koch, GG, Hinderliter, AL (2007). Relationship of depression to death or hospitalization in patients with heart failure. Archives of Internal Medicine 167, 367–373.Google Scholar
Smoller, JW, Allison, M, Cochrane, BB, Curb, JD, Perlis, RH, Robinson, JG, Rosal, MC, Wenger, NK, Wassertheil-Smoller, S (2009). Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study. Archives of Internal Medicine 169, 2128–2139.Google Scholar
Tata, LJ, West, J, Smith, C, Farrington, P, Card, T, Smeeth, L, Hubbard, R (2005). General population based study of the impact of tricyclic and selective serotonin reuptake inhibitor antidepressants on the risk of acute myocardial infarction. Heart 91, 465–471.Google Scholar
Taylor, CB, Youngblood, ME, Catellier, D, Veith, RC, Carney, RM, Burg, MM, Kaufmann, PG, Shuster, J, Mellman, T, Blumenthal, JA, Krishnan, R, Jaffe, AS (2005). Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. Archives of General Psychiatry 62, 792–798.Google Scholar
Thayer, JF, Lane, RD (2007). The role of vagal function in the risk for cardiovascular disease and mortality. Biological Psychology 74, 224–242.Google Scholar
Veith, RC, Raskind, MA, Barnes, RF, Gumbrecht, G, Ritchie, JL, Halter, JB (1983). Tricyclic antidepressants and supine, standing, and exercise plasma norepinephrine levels. Clinical Pharmacology and Therapeutics 33, 763–769.Google Scholar
Whang, W, Kubzansky, LD, Kawachi, I, Rexrode, KM, Kroenke, CH, Glynn, RJ, Garan, H, Albert, CM (2009). Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses’ Health Study. Journal of the American College of Cardiology 53, 950–958.Google Scholar
Whooley, MA, de Jonge, P, Vittinghoff, E, Otte, C, Moos, R, Carney, RM, Ali, S, Dowray, S, Na, B, Feldman, MD, Schiller, NB, Browner, WS (2008). Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. Journal of the American Medical Association 300, 2379–2388.Google Scholar
Xiong, GL, Jiang, W, Clare, R, Shaw, LK, Smith, PK, Mahaffey, KW, O'Connor, CM, Krishnan, KR, Newby, LK (2006). Prognosis of patients taking selective serotonin reuptake inhibitors before coronary artery bypass grafting. American Journal of Cardiology 98, 42–47.Google Scholar