SSRIs Are Safe, Effective in Easing Depression in Heart Failure

ATLANTA — Treatment with an antidepressant drug relieved the mild to moderate depression that often occurs in patients with heart failure in a controlled study with 26 patients.

But the reduction of depression symptoms using a selective serotonin reuptake inhibitor generally did not improve quality of life measures in these patients, Dr. Mark R. Vesely and his associates reported in a poster at the annual meeting of the American College of Cardiology.

The findings suggest physicians should screen for depression in patients with heart failure, then treat when depression is diagnosed, he said in an interview. Treatment with an SSRI is safe and effective. Next would be to examine whether treating depression can produce any reductions in hospitalization rates or death in heart failure patients, said Dr. Vesely, a cardiologist at the University of Maryland in Baltimore.

Results from previous studies have shown that depression occurs in 24%–48% of patients with heart failure. Despite this high prevalence, “heart failure patients usually don't get treated” for depression, said Dr. Stephen S. Gottlieb, professor of medicine and director of the heart failure service at the University of Maryland and a coinvestigator for the study.

An SSRI is the logical, first-line agent to use to treat depression in a patient with heart failure because of its presumed safety in these patients. By contrast, treatment with a tricyclic antidepressant involves the risk of producing neurohormonal activation that might exacerbate the heart failure, Dr. Vesely said.

The study included patients with New York Heart Association class II or III heart failure who were diagnosed with mild or moderate depression by a score of 10 or more on the Beck Depression Index (BDI). The average BDI score of the patients enrolled was about 21, and they were all placed on an optimal panel of heart failure medications.

The patients were randomized to treatment with either paroxetine-CR (Paxil CR) 12.5 mg daily or placebo for 12 weeks. During follow-up, three patients dropped out of the study. After 12 weeks, the BDI score fell by an average of 12 points in the 12 patients treated with paroxetine-CR for the full study, compared with an average 0.5 point rise in 11 placebo patients, a significant difference.

Quality of life was measured with several scales: the Minnesota Living With Heart Failure emotional and physical scales, and the mental and physical scales of the Short Form-36. There were no significant improvements for most of these measures in the paroxetine-treated patients compared with the controls. The sole exception was the mental score on the Short Form-36, which rose by 9 points in the actively treated patients and by 1 point in the placebo-treated patients, a significant difference.

GlaxoSmithKline, which markets Paxil CR, supplied the drug in this study. The study and investigators received no other industry support.

ATLANTA — Treatment with an antidepressant drug relieved the mild to moderate depression that often occurs in patients with heart failure in a controlled study with 26 patients.

But the reduction of depression symptoms using a selective serotonin reuptake inhibitor generally did not improve quality of life measures in these patients, Dr. Mark R. Vesely and his associates reported in a poster at the annual meeting of the American College of Cardiology.

The findings suggest physicians should screen for depression in patients with heart failure, then treat when depression is diagnosed, he said in an interview. Treatment with an SSRI is safe and effective. Next would be to examine whether treating depression can produce any reductions in hospitalization rates or death in heart failure patients, said Dr. Vesely, a cardiologist at the University of Maryland in Baltimore.

Results from previous studies have shown that depression occurs in 24%–48% of patients with heart failure. Despite this high prevalence, “heart failure patients usually don't get treated” for depression, said Dr. Stephen S. Gottlieb, professor of medicine and director of the heart failure service at the University of Maryland and a coinvestigator for the study.

An SSRI is the logical, first-line agent to use to treat depression in a patient with heart failure because of its presumed safety in these patients. By contrast, treatment with a tricyclic antidepressant involves the risk of producing neurohormonal activation that might exacerbate the heart failure, Dr. Vesely said.

The study included patients with New York Heart Association class II or III heart failure who were diagnosed with mild or moderate depression by a score of 10 or more on the Beck Depression Index (BDI). The average BDI score of the patients enrolled was about 21, and they were all placed on an optimal panel of heart failure medications.

The patients were randomized to treatment with either paroxetine-CR (Paxil CR) 12.5 mg daily or placebo for 12 weeks. During follow-up, three patients dropped out of the study. After 12 weeks, the BDI score fell by an average of 12 points in the 12 patients treated with paroxetine-CR for the full study, compared with an average 0.5 point rise in 11 placebo patients, a significant difference.

Quality of life was measured with several scales: the Minnesota Living With Heart Failure emotional and physical scales, and the mental and physical scales of the Short Form-36. There were no significant improvements for most of these measures in the paroxetine-treated patients compared with the controls. The sole exception was the mental score on the Short Form-36, which rose by 9 points in the actively treated patients and by 1 point in the placebo-treated patients, a significant difference.

GlaxoSmithKline, which markets Paxil CR, supplied the drug in this study. The study and investigators received no other industry support.

ATLANTA — Treatment with an antidepressant drug relieved the mild to moderate depression that often occurs in patients with heart failure in a controlled study with 26 patients.

But the reduction of depression symptoms using a selective serotonin reuptake inhibitor generally did not improve quality of life measures in these patients, Dr. Mark R. Vesely and his associates reported in a poster at the annual meeting of the American College of Cardiology.

The findings suggest physicians should screen for depression in patients with heart failure, then treat when depression is diagnosed, he said in an interview. Treatment with an SSRI is safe and effective. Next would be to examine whether treating depression can produce any reductions in hospitalization rates or death in heart failure patients, said Dr. Vesely, a cardiologist at the University of Maryland in Baltimore.

Results from previous studies have shown that depression occurs in 24%–48% of patients with heart failure. Despite this high prevalence, “heart failure patients usually don't get treated” for depression, said Dr. Stephen S. Gottlieb, professor of medicine and director of the heart failure service at the University of Maryland and a coinvestigator for the study.

An SSRI is the logical, first-line agent to use to treat depression in a patient with heart failure because of its presumed safety in these patients. By contrast, treatment with a tricyclic antidepressant involves the risk of producing neurohormonal activation that might exacerbate the heart failure, Dr. Vesely said.

The study included patients with New York Heart Association class II or III heart failure who were diagnosed with mild or moderate depression by a score of 10 or more on the Beck Depression Index (BDI). The average BDI score of the patients enrolled was about 21, and they were all placed on an optimal panel of heart failure medications.

The patients were randomized to treatment with either paroxetine-CR (Paxil CR) 12.5 mg daily or placebo for 12 weeks. During follow-up, three patients dropped out of the study. After 12 weeks, the BDI score fell by an average of 12 points in the 12 patients treated with paroxetine-CR for the full study, compared with an average 0.5 point rise in 11 placebo patients, a significant difference.

Quality of life was measured with several scales: the Minnesota Living With Heart Failure emotional and physical scales, and the mental and physical scales of the Short Form-36. There were no significant improvements for most of these measures in the paroxetine-treated patients compared with the controls. The sole exception was the mental score on the Short Form-36, which rose by 9 points in the actively treated patients and by 1 point in the placebo-treated patients, a significant difference.

GlaxoSmithKline, which markets Paxil CR, supplied the drug in this study. The study and investigators received no other industry support.