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Well, maybe not really, but you might think so if you read about this recent study and accompanying editorial in the Journal of the American College of Cardiology that is hot off the press (thanks to Marilyn Mann who is an ACC member for getting the paper for guys like us to review, when the paper isn’t even out yet even though they are blowing the press releases all over the mainstream media).
New New! Lolcat! I done wanna die!
This study looked at 63,469 women in the Nurses Health Study who didn’t have a history of heart disease, divided them into different levels of depression based on the self report Mental Health Inventory, and then followed them over several years. They found the usual associations between depression and risk of heart attack, but what was more interesting was the fact that women on antidepressants were three times as likely to have a sudden cardiac death than women not on antidepressants. This was pretty striking, and was not accounted for by other factors such as risk factors for heart disease. Granted, sudden cardiac death in healthy women is fairly rare, and in this study only 46/100,000 women on an SSRI had a sudden cardiac death.
Tricyclics have long been known to prolong the cardiac Q-T interval, so they could theoretically cause ventricular arrhythmia, leading to sudden death. The SSRIs have been promoted as being safer from this standpoint, however in the current study there were not any differences between SSRIs and “other antidepressants” in terms of sudden cardiac death.
The graph below shows the risk of sudden cardiac death over time. It is called a “survival curve” and shows what percentage of the women had died up to that point of time. The women who were most depressed and on antidepressants are the blue line; they were most likely to die. Behind them are nondepressed women on antidepressants, and women not on antidepressants.
We are climbing... Jacob's ladder...
Mrs. Bremner’s comment is that sudden cardiac events is fairly rare in otherwise healthy women, and antidepressants did not increase the risk of other cardiac events that are more common, like heart attack and stroke. Nevertheless she thinks it is worth paying attention to.
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I’m not actually a member of the ACC, just a subscriber to their journal. I AM a “Premium Professional” member of the American Heart Association, however. They even sent me an ID card and a lapel pin. How cool is that?
god I wish I could read this stuff…my brain is too fried thanks to the drugs…BUT I have lots of friends who say it will come back after being off the drugs long enough…so I’ve saved the PDFs to my desktop…thank you
wait, wait. I didn’t get the chance to put up my lolcat. It’s up there now.
Save ze lolcat!
But, Drs. B, why are women on antidepressants if they aren’t depressed? (Does this mean the ad worked but didn’t kill them?)
Also, wouldn’t the most severely depressed women be on antidepressants in the first place — and thus more vulnerable to cardio events (with or without SSRI)?
In other words, what about this study says “causation” and not “association”?
Just a rhetorical question.
I got to the cat…finally…
The editorial was written by Murray Stein who is a psychiatrists from UCSD I know well and his comment was just that, that the ones on antidepressants may be more likely to be depressed. The study controlled for MHI inventory scale scores (a measure of depression) but he argues that is self report and cites other studies that clinician diagnosed depression correlates better with cardiac outcomes.
I emailed him to get a copy of the paper but he didn’t have it so I had to send it to him via Marilyn Mann. LOL!
Hmmmmm, putting on my ADHD eyeglasses, I do wonder how many of these women actually had ADHD, not depression.
It often is missed in women, because ADHD tends to present differently (but not always) between the genders. And ADHD is widely misdiagnosed as depression and anxiety (because people with unrecognized ADHD symptoms often become “depressed” and anxious).
I can’t really make an intelligent case for it, but untreated ADHD, with all its stresses and common adrenaline-spiking activity (not to mention self-medicating habits) sure doesn’t seem compatible with a healthy cardiovascular system. And, SSRIs can worsen ADHD — something about backsuppressing dopamine in parts of the brain.
Just a thought.
OMG, I was just thinking off the top of my head. Pure speculation. But, a quick Google and…of course dopamine affects the cardiovascular system.
If anyone here can explain to me how “low dopamine” (whether through backsuppression created by SSRIs or through the receptors dying off with age) could increase the risk of cardiovascular events, I’d appreciate it.
my husband had a heart attack, then suffered depression and was given antidepressants. 4 months later he had a sudden cardiac arrest. Was lucky to be revived and lived.
[...] article is a repost from the Before You Take That Pill blog, March 10, [...]