title: Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: a randomized controlled trial.
abstract: OBJECTIVE
  Evaluating the effects of implementing an antidepressant treatment strategy in depressed myocardial infarction (MI)-patients on long-term cardiovascular outcomes and all-cause mortality.
  
  
  METHODS
  MI-patients were evaluated for the presence of a diagnosis of post-MI depression at 3, 6, 9 and 12months after hospitalization for MI. A total of 331 depressed MI-patients were randomized to intervention or care-as-usual (CAU). Patients randomized to the intervention were offered several antidepressant treatment options including pharmacological and non-pharmacological therapy. Patients randomized to CAU were not given feedback about their depression status. All patients were free to seek depression treatment outside the study, which was monitored. The primary outcome was a combined endpoint of cardiovascular events and cardiac mortality between randomization and 8years later. All-cause mortality was evaluated as secondary endpoint.
  
  
  RESULTS
  The intervention did not reduce the risk of the primary outcome (HR: 0.97 (95% CI: 0.67-1.40) n=330) or all-cause mortality (HR: 0.74 (95% CI: 0.41-1.33) n=330). Regardless of randomization status, patients who received depression treatment (n=168) had reduced all-cause mortality rates compared to those who did not receive treatment (n=143, HR: 0.52 (95% CI: 0.28-0.97)).
  
  
  CONCLUSIONS
  Implementing an antidepressant treatment strategy did not reduce the risk of cardiovascular morbidity and mortality compared to usual care. Receiving depression treatment increased survival. It remains unclear whether this represents a direct treatment effect or is due to unmeasured factors that relate to both receiving depression treatment and mortality, such as patients' intrinsic motivation to care for their health.
authors.affiliation: Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands. m.zuidersma@umcg.nl
authors.forename: Marij
authors.initials: M
authors.lastname: Zuidersma
authors.forename: Henk Jan
authors.initials: HJ
authors.lastname: Conradi
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.forename: Johan
authors.initials: J
authors.lastname: Ormel
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D009203:Myocardial Infarction / Q000401:mortality* / Q000523:psychology*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D011613:Psychotherapy; D012306:Risk; D055502:Secondary Prevention; D015996:Survival Rate
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D008803:Mianserin; D000078785:Mirtazapine