March 29, 2006
According to the results of a new observational study, patients with coronary artery disease or similar heart conditions may be at a significantly higher risk of death while using antidepressants like Prozac and Zoloft.
The study analyzed “the contribution of anxiety and depression to the risk of sudden cardiac death in patients with coronary artery disease,” the researchers said.
The study presenter, Dr. Lana L. Watkins, and her colleagues at Duke University controlled various factors that may contribute to an increased death risk such as age, degree of heart disease, and severity of depression.
The researchers monitored depressive symptoms and antidepressant use in 921 patients ages 29 to 90 who had been hospitalized for coronary angiography, a procedure used to identify heart disease. “All of the patients had a history of or current coronary artery disease,” Watkins said.
Almost 20 percent of the patients were using antidepressants and two thirds of the drugs used were selective serotonin reuptake inhibitor, a popular class of antidepressants that have recently been associated with serious adverse side effects such as suicidal behavior and birth defects. Paxil, Prozac, and Zoloft are all SSRI medications.
During the three-year follow up of the study, 21.4 percent of the patients that were using antidepressants died in comparison to only 12.5 percent who were not on the medications. The study found that antidepressant drug use in patients with coronary artery disease increased the risk of death by 62 percent.
However, researchers don’t encourage terminating the use of antidepressants since outside factors may also increase death risks. For example, Watkins said that patients taking antidepressant drugs were more depressed, which could lead to problems with the immune system or raise cardiovascular risk factors like high blood pressure, tobacco use, alcohol use, and other contributing factors for early death risks.
“The findings could just be coincidental,” Watkins said. “That is why it would be very premature for patients to stop taking their medications.” Random placebo-controlled trials are needed to verify the results of the Duke study.
For now, experts advise physicians to observe antidepressant use in their heart disease patients.
Duke researchers will begin conducting randomized trials to further evaluate the factors that may be increasing the risk of death in patients with coronary artery disease.
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