title: Antidepressant drug compliance: reduced risk of MI and mortality in depressed patients.
abstract: BACKGROUND
  The long-term risk of myocardial infarction (MI) associated with use of antidepressants is uncertain, especially for nontricyclic antidepressants. The present study uses a national Veterans Affairs cohort to test whether antidepressants increase or decrease risk of MI and all-cause mortality.
  
  
  METHODS
  US Department of Veterans Affairs patient records were analyzed to identify a cohort free of cardiovascular disease in fiscal years 1999 and 2000, aged 25-80 years, who had an International Classification of Diseases, Ninth Revision, Clinical Modification code indicating an episode of depression (n=93,653). Incident MI and all-cause mortality were modeled in patients who received 12 weeks or more of antidepressant pharmacotherapy as compared with 0-11 weeks during follow-up. Age-adjusted Cox proportional hazard models were computed before and after adjusting for baseline sociodemographics and time-dependent covariates.
  
  
  RESULTS
  Receipt of 12 or more weeks of continuous antidepressant therapy was associated with significantly reduced rates of incident MI across classes of antidepressants: selective serotonin reuptake inhibitor (SSRIs) (hazard ratio [HR] 0.48; 95% confidence interval [CI], 0.44-0.52), serotonin-norepinephrine reuptake inhibitors (SNRIs) (HR 0.35; 95% CI, 0.32-0.40), tricyclic antidepressants (TCAs) (HR 0.39; 95% CI, 0.34-0.44), and "Other" (HR 0.41; 95% CI, 0.37-0.45). Risk of all-cause mortality also was decreased with receipt of 12 weeks of pharmacotherapy with all classes of antidepressants (SSRI, SNRI, TCA, Other), with HRs ranging from 0.50 to 0.66.
  
  
  CONCLUSIONS
  Across classes of antidepressants, 12 weeks of pharmacotherapy appears to be safe in terms of MI risk. Although the mechanism for this association remains uncertain, it is possible that compliance with pharmacotherapy for depression reflects compliance with cardiovascular medications. It also is possible that a direct drug effect or improved depressed mood may attenuate the risk of MI in depressed patients.
authors: St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA. scherrej@psychiatry.wustl.edu
authors: Jeffrey F
authors: JF
authors: Scherrer
authors: Lauren D
authors: LD
authors: Garfield
authors: Patrick J
authors: PJ
authors: Lustman
authors: Paul J
authors: PJ
authors: Hauptman
authors: Timothy
authors: T
authors: Chrusciel
authors: Angelique
authors: A
authors: Zeringue
authors: Robert M
authors: RM
authors: Carney
authors: Kenneth E
authors: KE
authors: Freedland
authors: Kathleen K
authors: KK
authors: Bucholz
authors: Richard
authors: R
authors: Owen
authors: John W
authors: JW
authors: Newcomer
authors: William R
authors: WR
authors: True
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D010349:Patient Compliance; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents