Antidepressants may prevent heart attacks
By DrRich
A study reported in the October 16, 2001 issue of Circulation suggests that the use of selective serotonin reuptake inhibitors, or SSRIs (i.e., drugs like Prozac,) is associated with a reduced risk of heart attack.
The study, conducted by researchers at the University of Pennsylvania, compared the incidence of heart attacks in smokers taking SSRIs to the incidence of heart attacks in smokers who were not taking SSRIs. The smokers taking SSRIs had a significantly reduced risk of heart attack. The same reduction in risk was not seen with other types of antidepressant medications.
Skeptics note that this study was not a randomized, prospective trial - the kind that doctors and the FDA like to use when making clinical decisions - but instead was a retrospective telephone survey. This trial thus does not constitute "proof" that SSRI antidepressants prevent heart attacks, but only offers evidence that they may do so.
Nor does this study offer any indication of whether, if SSRIs truly do prevent heart attacks, they do so by treating depression, or by some aspirin-like effect on platelets. (Depression has been found in many studies to be a strong risk factor for heart attacks.) (Inhibition of platelets by aspirin or other drugs can significantly reduce the risk of heart attacks in some patients.)
Based on this study and on several other smaller studies that suggest the same result, it is likely that a large, randomized prospective trial will be conducted to see a) whether SSRI antidepressants actually do reduce the risk of heart attack, and b) if they do, whether they do so by treating depression or by some other mechanism. Until such a randomized trial is conducted, it is unlikely that doctors will prescribe SSRIs simply for the purpose of reducing heart attacks.
However, for people who are at high risk for heart attack and who suffer from depression, using SSRIs seems like a good idea - whatever the mechanism of their effect. Recognizing and treating clinical depression - especially in people at high risk for cardiovascular disease - should not await clinical trials whose results will not be known for several years.
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