Antidepressants, autonomic function and mortality in patients with coronary heart disease: data from the Heart and Soul Study

• Published in: Psychological medicine Vol. 44; no. 14; pp. 2975 - 2984
• Main Authors: Zimmermann-Viehoff, F., Kuehl, L. K., Danker-Hopfe, H., Whooley, M. A., Otte, C.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.10.2014
• Subjects: Aged; Antidepressants; Antidepressive Agents, Tricyclic - adverse effects; Autonomic Nervous System - drug effects; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Coronary Disease - mortality; Coronary Disease - psychology; Coronary heart disease; Female; Heart; Heart Rate - drug effects; Humans; Male; Medical sciences; Middle Aged; Mortality; Neuropharmacology; Norepinephrine - urine; Original Articles; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Serotonin Uptake Inhibitors - adverse effects; Side effects; Treatment Outcome; norepinephrine; mortality; heart rate variability; Coronary heart disease; selective serotonin reuptake inhibitors; tricyclic antidepressants; Heart; Human; Psychotropic; Mortality; Cardiovascular disease; Catecholamine; Tricyclic compound; Selective serotonin reuptake inhibitor; Heart rate; Neurotransmitter; Antidepressant agent; Norepinephrine; Circulatory system; Hemodynamics
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S003329171400066X

Antidepressants reduce depressive symptoms in patients with coronary heart disease, but they may be associated with increased mortality. This study aimed to examine whether the use of tricyclic antidepressants (TCA) or selective serotonin reuptake inhibitors (SSRI) is associated with mortality in patients with coronary heart disease, and to determine whether this association is mediated by autonomic function. A total of 956 patients with coronary heart disease were followed for a mean duration of 7.2 years. Autonomic function was assessed as heart rate variability, and plasma and 24-h urinary norepinephrine. Of 956 patients, 44 (4.6%) used TCA, 89 (9.3%) used SSRI, and 823 (86.1%) did not use antidepressants. At baseline, TCA users exhibited lower heart rate variability and higher norepinephrine levels compared with SSRI users and antidepressant non-users. At the end of the observational period, 52.3% of the TCA users had died compared with 38.2% in the SSRI group and 37.3% in the control group. The adjusted hazard ratio (HR) for TCA use compared with non-use was 1.74 [95% confidence interval (CI) 1.12-2.69, p = 0.01]. Further adjustment for measures of autonomic function reduced the association between TCA use and mortality (HR = 1.27, 95% CI 0.67-2.43, p = 0.47). SSRI use was not associated with mortality (HR = 1.15, 95% CI 0.81-1.64, p = 0.44). The use of TCA was associated with increased mortality. This association was at least partially mediated by differences in autonomic function. Our findings suggest that TCA should be avoided in patients with coronary heart disease.