March 10th, 2006

"Antidepressants May Pose Heightened Risk For Heart Patients"

A recent observational study found commonly used antidepressants like Prozac and Paxil may significantly increase the risk of death in patients with coronary artery disease.

Dr. Lana L. Watkins and her colleagues at Duke University evaluated symptoms of depression, anxiety, and antidepressant use in 921 patients who were hospitalized for coronary angiography, a process used to detect heart disease. Every patient in the study had a background of or current coronary artery disease.

Almost 20 percent of the patients used antidepressants, two-thirds of which were selective serotonin reuptake inhibitors (SSRIs), a popular class of antidepressants recently linked to serious side effects such as suicidal behavior and/or birth defects. Prozac, Paxil, and Zoloft are all SSRI drugs.

During the course of the three-year study, almost 22 percent of patients taking antidepressants died, compared to only 12.5 percent who were not using the drugs. The study concluded that antidepressant use increased the risk of death for patients with coronary artery disease by 62 percent.

However, experts do not encourage discontinuing the use of these drugs due to outside factors that may be contributing to the increased risks. “People with heart disease should definitely not stop taking their antidepressants, because we do not know if antidepressants were causing this (increased risk) or if it was due to some other characteristics of folks who are on antidepressants,” said study presenter, Dr. Watkins.

According to Watkins, patients who take antidepressants are more depressed, which may lead to complications of the immune system or heighten cardiovascular risk factors such as high blood pressure, tobacco, and alcohol use, all factors for early death risks.

“The findings could just be coincidental,” she said. “That is why it would be very premature for patients to stop taking their medications.” Random placebo-controlled trials are necessary to confirm the results of the Duke study.

In the meantime, experts advise physicians to monitor antidepressant use in their heart disease patients.

Duke researchers plan on conducting randomized trials to further study the factors contributing to death risks in patients with coronary artery disease.