title: Antiplatelet effects of antidepressant treatment: a randomized comparison between escitalopram and nortriptyline.
abstract: BACKGROUND
  Depressive disorders have been identified as independent risk factors for coronary heart disease. The present study (i) compared platelet function of depressed patients with that of healthy controls, (ii) analysed possible aggregability changes during 3 months of treatment with antidepressants, and (iii) sought to assess different effects of escitalopram and nortriptyline on platelet aggregation.
  
  
  METHODS
  Blood samples of 91 major depressed patients and 91 healthy controls were analysed with whole blood aggregometry in a case-control setting. Depressed patients were randomized to two groups treated either with escitalopram (n=47) or nortriptyline (n=44). Platelet aggregation was studied on days 0, 1, 3, 7, 14, 21, 84 of continuing medication and was determined in response to adenosine diphosphate (ADP) and collagen.
  
  
  RESULTS
  Platelet aggregation induced by ADP was increased among depressive patients compared with that of healthy controls (26%, p=0.006). With antidepressant treatment, changes in platelet aggregation remained comparable in both groups at early time points (d1 to 21). In contrast, at day 84, patients with antidepressive response revealed significant differences in both medication groups: Patients receiving escitalopram showed a 23% decrease of ADP induced aggregation (p=0.03) and a 15% decrease of collagen induced aggregation (p=0.03). With nortriptyline the increase in impedance was reduced by 29% after ADP induction (p=0.046).
  
  
  CONCLUSIONS
  Depressed patients have higher ex vivo platelet aggregation that may contribute to increased cardiovascular morbidity. After three months of antidepressant treatment with either escitalopram or nortriptyline, platelet aggregation was significantly reduced in antidepressant responders, irrespective of the antidepressant medication type.
authors.affiliation: Department of Internal Medicine II - Cardiology, University of Bonn, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Flöck
authors.forename: Astrid
authors.initials: A
authors.lastname: Zobel
authors.forename: Gerhard
authors.initials: G
authors.lastname: Bauriedel
authors.forename: Izabela
authors.initials: I
authors.lastname: Tuleta
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Susanne
authors.initials: S
authors.lastname: Höfels
authors.forename: Anna
authors.initials: A
authors.lastname: Schuhmacher
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Dirk
authors.initials: D
authors.lastname: Skowasch
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects; D015283:Citalopram / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use*; D010974:Platelet Aggregation / Q000187:drug effects*
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D009661:Nortriptyline