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

Published online by Cambridge University Press:  25 March 2014

F. Zimmermann-Viehoff ,
L. K. Kuehl ,
H. Danker-Hopfe ,
M. A. Whooley  and
C. Otte
F. Zimmermann-Viehoff
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
L. K. Kuehl
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
H. Danker-Hopfe
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
M. A. Whooley
Affiliation:
VA Medical Center, San Francisco, CA, USA University of California, Department of Medicine and of Epidemiology and Biostatistics, San Francisco, CA, USA
C. Otte*
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany
*
*Address for correspondence: C. Otte, M.D., Department of Psychiatry and Psychotherapy, Charité University Medical School Berlin, Eschenallee 3, 14050 Berlin, Germany. (Email: christian.otte@charite.de)
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Abstract

Background

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.

Method

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.

Results

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).

Conclusions

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.

Keywords

Coronary heart diseaseheart rate variabilitymortalitynorepinephrineselective serotonin reuptake inhibitorstricyclic antidepressants
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 14 , October 2014 , pp. 2975 - 2984
Copyright
Copyright © Cambridge University Press 2014 

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