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.	陳偉偉, 高潤霖, 劉力生, 等. 《中國心血管病報告 2014》概要. 中國循環雜志, 2016, 31(6): 617-622.
2.	艾聰, 李光校, 周波, 等. 中國 2000 年后急性心肌梗死患者抑郁患病率的 Meta 分析. 中國循證醫學雜志, 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.
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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, 蒙華慶, 羅慶華. 氟西汀干預伴焦慮、抑郁狀態急性心肌梗死患者的效果. 中國臨床康復, 2006, 34(14): 16-17.
16.	劉駿達, 鄭暉. 氟西汀治療心肌梗塞伴發抑郁. 臨床精神醫學雜志, 1999, 3(4): 210-211.
17.	李錦爽, 王萬虹, 程勇. 西酞普蘭對急性心肌梗死 PCI 術后伴發抑郁預后的影響. 中國心血管病研究, 2014, 12(7): 653-655.
18.	邱忠霞, 王滌非, 馬賀軍. 老年心肌梗死后抑郁癥及其治療. 中華老年心腦血管病雜志, 2005, 24(1): 24-26.
19.	鄭瓊, 肖繼紅, 張衛. 氟西汀治療伴有焦慮抑郁癥狀的急性心肌梗死患者療效分析. 寧夏醫學雜志, 2004, 12(3): 140-141.
20.	陳天寶. 舍曲林治療急性心肌梗死后抑郁癥患者的療效觀察. 福建醫藥雜志, 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.	趙國慶, 張晨, 陳俊, 等. 抑郁癥與代謝綜合征關系的研究進展. 中華精神科雜志, 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. 陳偉偉, 高潤霖, 劉力生, 等. 《中國心血管病報告 2014》概要. 中國循環雜志, 2016, 31(6): 617-622.
2. 艾聰, 李光校, 周波, 等. 中國 2000 年后急性心肌梗死患者抑郁患病率的 Meta 分析. 中國循證醫學雜志, 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, 蒙華慶, 羅慶華. 氟西汀干預伴焦慮、抑郁狀態急性心肌梗死患者的效果. 中國臨床康復, 2006, 34(14): 16-17.
16. 劉駿達, 鄭暉. 氟西汀治療心肌梗塞伴發抑郁. 臨床精神醫學雜志, 1999, 3(4): 210-211.
17. 李錦爽, 王萬虹, 程勇. 西酞普蘭對急性心肌梗死 PCI 術后伴發抑郁預后的影響. 中國心血管病研究, 2014, 12(7): 653-655.
18. 邱忠霞, 王滌非, 馬賀軍. 老年心肌梗死后抑郁癥及其治療. 中華老年心腦血管病雜志, 2005, 24(1): 24-26.
19. 鄭瓊, 肖繼紅, 張衛. 氟西汀治療伴有焦慮抑郁癥狀的急性心肌梗死患者療效分析. 寧夏醫學雜志, 2004, 12(3): 140-141.
20. 陳天寶. 舍曲林治療急性心肌梗死后抑郁癥患者的療效觀察. 福建醫藥雜志, 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. 趙國慶, 張晨, 陳俊, 等. 抑郁癥與代謝綜合征關系的研究進展. 中華精神科雜志, 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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