Efficacy and safety of newer-generation antidepressants for patients with myocardial infarction and depression: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Wei ¹ , ZHANG Yuqing ² , MENG Huaqing ³ ,  DENG Guolan ¹ ,  ZHOU Xinyu ³

1. Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;
2. Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;
3. Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding author：

DENG Guolan, Email: dengguolan0201@163.com; ZHOU Xinyu, Email: xinyu973@126.com

Keywords：

Antidepressant; Myocardial infarction; Depression; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201801101

Video：

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ObjectivesTo evaluate the efficacy and safety of newer-generation antidepressants for patients with myocardial infarction (MI) and depression.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, CBM, CNKI, WanFang Data, and VIP databases were searched from inception to December 2017 to collect randomized controlled trials (RCT) on newer-generation antidepressants for patients with MI and depression. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsTen RCTs involving 552 participants were included. The results showed that the antidepressant group was superior to the placebo or treatment group in terms of the improvement of depressive symptoms (SMD=–1.38, 95%CI –1.93 to –0.82, P<0.000 01), and incidence of angina (RR=0.42, 95%CI 0.25 to 0.71,P=0.001), recurrent MI (RR=0.43, 95%CI 0.22 to 0.83, P=0.01), and re-hospitalization for cardiac reasons (RR=0.51, 95%CI 0.28 to 0.92, P=0.03). However, there were no significant differences between two groups on all-cause mortality (RR=0.45, 95%CI 0.18 to 1.11, P=0.08), cardiovascular mortality (RR=0.53, 95%CI 0.16 to 1.73, P=0.29) and incidence of heart failure (RR=0.75, 95%CI 0.39 to 1.43, P=0.38). Subgroup analysis revealed that the type of antidepressants could affect the improvement of depression outcome. Citalopram and fluoxetine might be the most effective drugs for patients with MI and depression.ConclusionsNewer-generation antidepressants are effective for treatment of depressive symptoms in patients with MI and depression, with no significant impact on all-cause mortality and cardiovascular mortality. Moreover, antidepressants can reduce the incidence of angina, recurrent MI, and re-hospitalization for cardiac reasons in patients suffering from MI and depression. Due to limited quantity and quality of included studies, more high quality studies are required to verify above conclusions.

Citation： ZHOU Wei, ZHANG Yuqing, MENG Huaqing, DENG Guolan, ZHOU Xinyu. Efficacy and safety of newer-generation antidepressants for patients with myocardial infarction and depression: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(7): 715-720. doi: 10.7507/1672-2531.201801101 Copy

1.	陈伟伟, 高润霖, 刘力生, 等. 《中国心血管病报告 2014》概要. 中国循环杂志, 2016, 31(6): 617-622.
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6.	Richards SH, Anderson L, Jenkinson CE, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev, 2017, (4): CD002902.
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16.	刘骏达, 郑晖. 氟西汀治疗心肌梗塞伴发抑郁. 临床精神医学杂志, 1999, 3(4): 210-211.
17.	李锦爽, 王万虹, 程勇. 西酞普兰对急性心肌梗死 PCI 术后伴发抑郁预后的影响. 中国心血管病研究, 2014, 12(7): 653-655.
18.	邱忠霞, 王涤非, 马贺军. 老年心肌梗死后抑郁症及其治疗. 中华老年心脑血管病杂志, 2005, 24(1): 24-26.
19.	郑琼, 肖继红, 张卫. 氟西汀治疗伴有焦虑抑郁症状的急性心肌梗死患者疗效分析. 宁夏医学杂志, 2004, 12(3): 140-141.
20.	陈天宝. 舍曲林治疗急性心肌梗死后抑郁症患者的疗效观察. 福建医药杂志, 2014, 36(1): 89-91.
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24.	Mazza M, Lotrionte M, Biondi-Zoccai G, et al. Selective serotonin reuptake inhibitors provide significant lower re-hospitalization rates in patients recovering from acute coronary syndromes: evidence from a meta-analysis. J Psychopharmacol, 2010, 24(12): 1785-1792.
25.	赵国庆, 张晨, 陈俊, 等. 抑郁症与代谢综合征关系的研究进展. 中华精神科杂志, 2016, 49(4) :261-264.
26.	Vancampfort D, Correll CU, Wampers M, et al. Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalence and moderating variables. Psychol Med, 2014, 44(10): 2017-2028.

1. 陈伟伟, 高润霖, 刘力生, 等. 《中国心血管病报告 2014》概要. 中国循环杂志, 2016, 31(6): 617-622.
2. 艾聪, 李光校, 周波, 等. 中国 2000 年后急性心肌梗死患者抑郁患病率的 Meta 分析. 中国循证医学杂志, 2017, 17(1): 47-51.
3. Meijer A, Conradi HJ, Bos EH, et al. Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. Br J Psychiatry, 2013, 203(2): 90-102.
4. Frasure-Smith N, Lespérance F, Gravel G, et al. Depression and health-care costs during the first year following myocardial infarction. J Psychosom Res, 2000, 48(4-5): 471-478.
5. Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations. a scientific statement from the American heart association. Circulation, 2014, 129(12): 1350-1369.
6. Richards SH, Anderson L, Jenkinson CE, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev, 2017, (4): CD002902.
7. Taylor CB, Youngblood ME, Catellier D, et al. Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. Arch Gen Psychiatry, 2005, 62(7): 792-798.
8. Shapiro PA. Management of depression after myocardial infarction. Curr Cardiol Rep, 2015, 17(10): 80.
9. Spindelegger CJ, Papageorgiou K, Grohmann R, et al. Cardiovascular adverse reactions during antidepressant treatment: a drug surveillance report of German-speaking countries between 1993 and 2010. Int J Neuropsychopharmacol, 2014, 18(4): pyu080.
10. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Available at: http://handbook.cochrane.org.
11. Honig A, Kuyper AM, Schene AH, et al. Treatment of post-myocardial infarction depressive disorder: a randomized, placebo-controlled trial with mirtazapine. Psychosom Med, 2007, 69(7): 606-613.
12. McFarlane A, Kamath MV, Fallen EL, et al. Effect of sertraline on the recovery rate of cardiac autonomic function in depressed patients after acute myocardial infarction. Am Heart J, 2001, 142(4): 617-623.
13. Mohapatra PK, Kar N, Kar GC, et al. Effectiveness of sertraline in treatment of depression in a consecutive sample of patients with acute myocardial infarction: six month prospective study on outcome. Clin Pract Epidemiol Ment Health, 2005, 1: 26.
14. Strik JJ, Honig A, Lousberg R, et al. Efficacy and safety of fluoxetine in the treatment of patients with major depression after first myocardial infarction: findings from a double-blind, placebo-controlled trial. Psychosom Med, 2000, 62(6): 783-789.
15. 傅一笑, 蒙华庆, 罗庆华. 氟西汀干预伴焦虑、抑郁状态急性心肌梗死患者的效果. 中国临床康复, 2006, 34(14): 16-17.
16. 刘骏达, 郑晖. 氟西汀治疗心肌梗塞伴发抑郁. 临床精神医学杂志, 1999, 3(4): 210-211.
17. 李锦爽, 王万虹, 程勇. 西酞普兰对急性心肌梗死 PCI 术后伴发抑郁预后的影响. 中国心血管病研究, 2014, 12(7): 653-655.
18. 邱忠霞, 王涤非, 马贺军. 老年心肌梗死后抑郁症及其治疗. 中华老年心脑血管病杂志, 2005, 24(1): 24-26.
19. 郑琼, 肖继红, 张卫. 氟西汀治疗伴有焦虑抑郁症状的急性心肌梗死患者疗效分析. 宁夏医学杂志, 2004, 12(3): 140-141.
20. 陈天宝. 舍曲林治疗急性心肌梗死后抑郁症患者的疗效观察. 福建医药杂志, 2014, 36(1): 89-91.
21. Centers for Disease Control and Prevention (CDC). Million hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors—United States, 2011. MMWR Morb Mortal Wkly Rep, 2011, 60(36): 1248-1251.
22. Qaseem A, Barry MJ, Kansagara D, et al. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American college of Physicians. Ann Intern Med, 2016, 164(5): 350-359.
23. Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev, 2011(9): CD008012.
24. Mazza M, Lotrionte M, Biondi-Zoccai G, et al. Selective serotonin reuptake inhibitors provide significant lower re-hospitalization rates in patients recovering from acute coronary syndromes: evidence from a meta-analysis. J Psychopharmacol, 2010, 24(12): 1785-1792.
25. 赵国庆, 张晨, 陈俊, 等. 抑郁症与代谢综合征关系的研究进展. 中华精神科杂志, 2016, 49(4) :261-264.
26. Vancampfort D, Correll CU, Wampers M, et al. Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalence and moderating variables. Psychol Med, 2014, 44(10): 2017-2028.

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