title: Depression requiring anti-depressant drug therapy in adult congenital heart disease: prevalence, risk factors, and prognostic value.
abstract: BACKGROUND
  Depression is prevalent in adults with congenital heart disease (ACHD), but limited data on the frequency of anti-depressant drug (ADD) therapy and its impact on outcome are available.
  
  
  RESULTS
  We identified all ACHD patients treated with ADDs between 2000 and 2011 at our centre. Of 6162 patients under follow-up, 204 (3.3%) patients were on ADD therapy. The majority of patients were treated with selective serotonin-reuptake inhibitors (67.4%), while only 17.0% of patients received tricyclic anti-depressants. Twice as many female patients used ADDs compared with males (4.4 vs. 2.2%, P < 0.0001). The percentage of patients on ADDs increased with disease complexity (P < 0.0001) and patient age (P < 0.0001). Over a median follow-up of 11.1 years, 507 (8.2%) patients died. After propensity score matching, ADD use was found to be significantly associated with worse outcome in male ACHD patients [hazard ratio 1.44 (95% confidence interval 1.17-1.84)]. There was no evidence that this excess mortality was directly related to ADD therapy, QT-prolongation, or malignant arrhythmias. However, males taking ADDs were also more likely to miss scheduled follow-up appointments compared with untreated counterparts, while no such difference in clinic attendance was seen in females.
  
  
  CONCLUSIONS
  The use of ADD therapy in ACHD relates to gender, age, and disease complexity. Although, twice as many female patients were on ADDs, it were their male counterparts, who were at increased mortality risk on therapy. Furthermore, males on ADDs had worse adherence to scheduled appointments suggesting the need for special medical attention and possibly psychosocial intervention for this group of patients.
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany gerhard.diller@gmail.com.
authors: Gerhard-Paul
authors: GP
authors: Diller
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany.
authors: Andrea
authors: A
authors: Bräutigam
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK.
authors: Aleksander
authors: A
authors: Kempny
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK.
authors: Anselm
authors: A
authors: Uebing
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK.
authors: Rafael
authors: R
authors: Alonso-Gonzalez
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK.
authors: Lorna
authors: L
authors: Swan
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK.
authors: Sonya V
authors: SV
authors: Babu-Narayan
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany.
authors: Helmut
authors: H
authors: Baumgartner
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK.
authors: Konstantinos
authors: K
authors: Dimopoulos
authors: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK.
authors: Michael A
authors: MA
authors: Gatzoulis
mesh_terms: D000328:Adult; D017677:Age Distribution; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002423:Cause of Death; D003866:Depressive Disorder / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000523:psychology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008133:Long QT Syndrome / Q000401:mortality / Q000523:psychology; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D017678:Sex Distribution
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Adult congenital heart disease; Depression; Mortality; Outcome