Wurzburg, Germany—Depression prevalence in patients with heart failure is estimated to be between 10% and 40%, depending on disease severity. The mental health issue also has been shown to be an independent predictor of mortality and rehospitalization in patients with heart failure, with incidence rates increasing along with depression severity.
Yet past research doesn’t suggest that antidepressants have helped much in the short term.
A recent study in the Journal of the American Medical Association sought to determine if selective serotonin reuptake inhibitors (SSRIs), which are widely used to treat depression, demonstrate long-term efficacy and safety for patients with heart failure and depression.
A team led by researchers from University Hospital Wurzburg in Germany examined whether 24 months of treatment with the antidepressant escitalopram improved mortality, illness, and mood in patients with chronic heart failure and depression.
For the study, 372 patients with chronic heart failure with reduced ejection fraction and depression were randomly assigned to receive escitalopram or matching placebo, in addition to optimal heart failure therapy.
Results indicate that, over a median participation time of 18.4 months for the escitalopram group and 18.7 months for the placebo group, the primary outcome of death or hospitalization occurred in 63% of patients in the SSRI group and 64% of the patients receiving no medication. Furthermore, no significant improvement on a measure of depression was identified for patients in the escitalopram group.
“In patients with chronic heart failure with reduced ejection fraction and depression, 18 months of treatment with escitalopram compared with placebo did not significantly reduce all-cause mortality or hospitalization, and there was no significant improvement in depression. These findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression,” the authors conclude.
The results are similar to those of the Sertraline Antidepressant Heart Attack Randomized Trial and the Enhancing Recovery in Coronary Heart Disease study, both of which enrolled patients with coronary disease and depression and found no beneficial effects with six months of antidepressant treatment, the researchers added.
“Although the efficacy of escitalopram for treating primary depression is considered superior to that of sertraline, and although the treatment duration in the current trial was extended to 24 months compared with only 12 weeks in the SADHART-CHF trial,” study authors added, “treatment with escitalopram had no beneficial effect in our patients who were diagnosed as having a major depressive disorder according to the DSM-IV but had baseline MADRS scores indicative of only mild to moderate depression.”
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