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Prim Care Companion CNS Disord. 2013;15(5). pii: PCC.13r01509. doi: 10.4088/PCC.13r01509. Epub 2013 Oct 24.

Depression treatment in patients with coronary artery disease: a systematic review.

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1
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York (Drs Ramamurthy and Faraone); and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Dr Trejo).

Abstract

OBJECTIVE:

Depression has been linked to adverse coronary artery disease outcomes. Whether depression treatment improves or worsens coronary artery disease prognosis is unclear. This 25-year systematic review examines medical outcomes, and, secondarily, mood outcomes of depression treatment among patients with coronary artery disease.

DATA SOURCES:

We systematically reviewed the past 25 years (January 1, 1986-December 31, 2011) of prospective trials reporting on the medical outcomes of depression treatment among patients with established coronary artery disease using keywords and MESH terms from OVID MEDLINE. Search 1 combined depression AND coronary artery disease AND antidepressants. Search 2 combined depression AND coronary artery disease AND psychotherapy. Search 3 combined depression AND revascularization AND antidepressants OR psychotherapy.

STUDY SELECTION:

English-language longitudinal randomized controlled trials, with at least 50 depressed coronary artery disease patients, reporting the impact of psychotherapy and/or antidepressants on cardiac and mood outcomes were included.

DATA EXTRACTION:

Data extracted included author name, year published, number of participants, enrollment criteria, depression definition/measures (standardized interviews, rating scales), power analyses, description of control arms and interventions (psychotherapy and/or medications), randomization, blinding, follow-up duration, follow-up loss, depression scores, and medical outcomes Results: The review yielded 10 trials. Antidepressant and/or psychotherapy did not significantly influence coronary artery disease outcomes in the overall population, but most studies were underpowered. There was a trend toward worse coronary artery disease outcomes after treatment with bupropion.

CONCLUSIONS:

After an acute coronary syndrome, depression often spontaneously remitted without treatment. Post-acute coronary syndrome persistence of depression predicted adverse coronary artery disease outcomes. Antidepressant and/or psychotherapy, particularly as part of the Coronary Psychosocial Evaluation Studies intervention, may improve prognosis in persistent depression among post-acute coronary syndrome patients. Noradrenergic antidepressants should be prescribed cautiously in patients with coronary artery disease.

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