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Comparison of Treatment Rates of Depression After Stroke Versus Myocardial Infarction: A Systematic Review and Meta-Analysis of Observational Data. Psychosom Med 2018; 80:754-763. [PMID: 30113911 DOI: 10.1097/psy.0000000000000632] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Depression after stroke and myocardial infarction (MI) is common but often assumed to be undertreated without reliable evidence being available. Thus, we aimed to determine treatment rates and investigate the application of guidelines in these conditions. METHODS Databases MEDLINE, EMBASE, PsycInfo, Web of Science, CINAHL, and Scopus were systematically searched without language restriction from inception to June 30, 2017. Prospective observational studies with consecutive recruitment reporting any antidepressant treatment in adults with depression after stroke or MI were included. Random-effects models were used to calculate pooled estimates of treatment rates. RESULTS Fifty-five studies reported 32 stroke cohorts (n = 8938; pooled frequency of depression = 34%, 95% confidence interval [CI] = 29%-38%) and 17 MI cohorts (n = 10,767; pooled frequency of depression = 24%, 95% CI = 20%-28%). In 29 stroke cohorts, 24% (95% CI = 20%-27%) of 2280 depressed people used antidepressant medication. In 15 MI cohorts, 14% (95% CI = 8%-19%) of 2381 depressed people used antidepressant medication indicating a lower treatment rate than in stroke. Two studies reported use of psychosocial interventions, indicating that less than 10% of participants were treated. CONCLUSIONS Despite the high frequency of depression after stroke and MI and the existence of efficacious treatment strategies, people often remain untreated. Innovative strategies are needed to increase the use of effective antidepressive interventions in patients with cardiovascular disease.
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Grace SL, Medina-Inojosa JR, Thomas RJ, Krause H, Douglas KV, Palmer B, Lopez-Jimenez F. Antidepressant Use by Class: Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87. [PMID: 29533962 PMCID: PMC6010164 DOI: 10.1159/000486794] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. METHODS This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. RESULTS There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre- (4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05-2.41) and those on SSRI (HR = 1.45; 95% CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43-1.82). CONCLUSION The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.
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Affiliation(s)
- Sherry L. Grace
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada, M5T 2S8,School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3
| | - Jose R. Medina-Inojosa
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Randal J. Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Heather Krause
- Datassist, Centre for Social Innovation, 215 Spadina Avenue, Toronto, Ontario, Canada, M5T2C7
| | - Kristin Vickers Douglas
- Department of Psychology and Psychiatry, Mayo Clinic Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Brian Palmer
- Department of Psychology and Psychiatry, Mayo Clinic Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
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Depression screening and treatment recall in male and female coronary artery disease inpatients: Association with symptoms one year later. Heart Lung 2017; 46:153-158. [PMID: 28336081 DOI: 10.1016/j.hrtlng.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 01/22/2017] [Accepted: 02/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study examined whether cardiac inpatients recall depression screening and how it is related to depressive symptoms and treatment one year later. METHODS 2635 cardiac inpatients from 11 hospitals completed a survey and were mailed a follow-up survey one year later; both surveys included the BDI-II. RESULTS Of the 1809 (68.7%) retained participants, 513 (30.0%) recalled depression screening. Recall was not significantly related to depressive symptoms at either time point (P > 0.05). Participants who were recommended antidepressants had higher BDI-II scores than those who were not, both as inpatients (P < 0.01) and one year later (P < 0.05). There was no significant change in depressive symptoms over time in patients who received any type of therapy. CONCLUSION Less than one-third of cardiac inpatients recalled being screened for depression. Recall of screening was not significantly related to depressive symptoms, and use of treatment was related to greater symptoms.
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Hurley MC, Arthur HM, Chessex C, Oh P, Turk-Adawi K, Grace SL. Burden, screening, and treatment of depressive and anxious symptoms among women referred to cardiac rehabilitation: a prospective study. BMC WOMENS HEALTH 2017; 17:11. [PMID: 28173855 PMCID: PMC5297254 DOI: 10.1186/s12905-017-0367-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/31/2017] [Indexed: 11/18/2022]
Abstract
Background Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality among women. Women with CVD experience a greater burden of psychosocial distress than men, and practice guidelines promote screening in cardiac patients, especially women. The objectives herein were to describe the burden of psychosocial distress, extent of screening, forms of treatment, and whether receipt of treatment was related to psychosocial distress symptom severity at follow-up, among women. Methods Within a multi-center trial of women randomized to cardiac rehabilitation models, consenting participants were asked to complete surveys upon consent and 6 months later. Clinical data were extracted from charts. This study presents a secondary analysis of the surveys, including investigator-generated items assessing screening and treatment, the Beck Depression Inventory-II, the Hospital Anxiety and Depression Scale, and Patient Health Questionnaire-2. Results Of the 128 (67.0%) participants with valid baseline and follow-up survey results, 48 (40.3%) self-reported that they recalled being screened, and of these, 10 (21.3%) recalled discussing the results with a health care professional. Fifty-six (43.8%) retained participants had elevated symptoms of psychosocial distress at baseline, of which 25 (44.6%) were receiving treatment. Regression analyses showed that treatment of psychosocial distress was not significantly associated with follow-up depressive symptoms, but was significantly associated with greater follow-up anxiety. Conclusions Findings reiterate the great burden of psychosocial distress among women with CVD. Less than half of patients with elevated symptoms were treated, and the treatment approaches appeared to insufficiently achieve symptom relief.
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Affiliation(s)
- Megan C Hurley
- School of Kinesiology and Health Science, York University, 368 Bethune College-4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.,University Health Network, Toronto, Ontario, Canada
| | | | | | - Paul Oh
- University Health Network, Toronto, Ontario, Canada
| | | | - Sherry L Grace
- School of Kinesiology and Health Science, York University, 368 Bethune College-4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada. .,University Health Network, Toronto, Ontario, Canada.
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Antidepressants and cardiovascular adverse events: A narrative review. ARYA ATHEROSCLEROSIS 2015; 11:295-304. [PMID: 26715935 PMCID: PMC4680078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Major depression or deterioration of previous mood disorders is a common adverse consequence of coronary heart disease, heart failure, and cardiac revascularization procedures. Therefore, treatment of depression is expected to result in improvement of mood condition in these patients. Despite demonstrated effects of anti-depressive treatment in heart disease patients, the use of some antidepressants have shown to be associated with some adverse cardiac and non-cardiac events. In this narrative review, the authors aimed to first assess the findings of published studies on beneficial and also harmful effects of different types of antidepressants used in patients with heart diseases. Finally, a new categorization for selecting antidepressants according to their cardiovascular effects was described. METHODS Using PubMed, Web of Science, SCOPUS, Index Copernicus, CINAHL, and Cochrane Database, we identified studies designed to evaluate the effects of depression and also using antidepressants on cardiovascular outcome. A 40 studies were finally assessed systematically. Among those eligible studies, 14 were cohort or historical cohort studies, 15 were randomized clinical trial, 4 were retrospective were case-control studies, 3 were meta-analyses and 2 animal studies, and 2 case studies. RESULTS According to the current review, we recommend to divide antidepressants into three categories based on the severity of cardiovascular adverse consequences including (1) the safest drugs including those drugs with cardio-protective effects on ventricular function, as well as cardiac conductive system including selective serotonin reuptake inhibitors, (2) neutralized drugs with no evidenced effects on cardiovascular system including serotonin-norepinephrine reuptake inhibitors, and (3) harmful drugs with adverse effects on cardiac function, hemodynamic stability, and heart rate variability including tricyclic antidepressants, serotonin antagonist and reuptake inhibitors, and noradrenergic and specific serotonergic antidepressants. CONCLUSION The presented categorization of antidepressants can be clinically helpful to have the best selection for antidepressants to minimizing their cardiovascular harmful effects.
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Czarny MJ, Arthurs E, Coffie DF, Smith C, Steele RJ, Ziegelstein RC, Thombs BD. Prevalence of antidepressant prescription or use in patients with acute coronary syndrome: a systematic review. PLoS One 2011; 6:e27671. [PMID: 22132126 PMCID: PMC3222644 DOI: 10.1371/journal.pone.0027671] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 10/21/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression is common among acute coronary syndrome (ACS) patients and is associated with poor prognosis. Cardiac side effects of older antidepressants were well-known, but newer antidepressants are generally thought of as safe to use in patients with heart disease. The objective was to assess rates of antidepressant use or prescription to patients within a year of an ACS. METHODS PubMed, PsycINFO, and CINAHL databases searched through May 29, 2009; manual searching of 33 journals from May 2009 to September 2010. Articles in any language were included if they reported point or period prevalence of antidepressant use or prescription in the 12 months prior or subsequent to an ACS for ≥100 patients. Two investigators independently selected studies for inclusion/exclusion and extracted methodological characteristics and outcomes from included studies (study setting, inclusion/exclusion criteria, sample size, prevalence of antidepressant prescription/use, method of assessing antidepressant prescription/use, time period of assessment). RESULTS A total of 24 articles were included. The majority were from North America and Europe, and most utilized chart review or self-report to assess antidepressant use or prescription. Although there was substantial heterogeneity in results, overall, rates of antidepressant use or prescription increased from less than 5% prior to 1995 to 10-15% after 2000. In general, studies from North America reported substantially higher rates than studies from Europe, approximately 5% higher among studies that used chart or self-report data. CONCLUSIONS Antidepressant use or prescription has increased considerably, and by 2005 approximately 10% to 15% of ACS patients were prescribed or using one of these drugs.
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Affiliation(s)
- Matthew J. Czarny
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Erin Arthurs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Diana-Frances Coffie
- Department of Medicine, Rhode Island Hospital, Providence, Rhode Island, United States of America
- Brown Alpert Medical School, Providence, Rhode Island, United States of America
| | - Cheri Smith
- Harold E. Harrison Medical Library, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States of America
| | - Russell J. Steele
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - Roy C. Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- School of Nursing, McGill University, Montreal, Quebec, Canada
- * E-mail:
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Gravely-Witte S, Stewart DE, Suskin N, Grace SL. The association among depressive symptoms, smoking status and antidepressant use in cardiac outpatients. J Behav Med 2009; 32:478-90. [PMID: 19504177 DOI: 10.1007/s10865-009-9218-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 05/14/2009] [Indexed: 01/20/2023]
Abstract
Both depression and smoking are highly prevalent and related to poorer outcomes in cardiac patients. In this study, the authors examined the association between depressive symptoms and smoking status, described the frequency and type of antidepressant use, and prospectively tested the effects of antidepressant use in smokers on smoking status and psychosocial outcomes. Participants comprised 1,498 coronary artery disease (CAD) outpatients who completed a baseline survey which assessed depressive symptoms, current medications, and smoking status. A second survey was mailed 9 months later that assessed depressive symptoms, anxiety, insomnia and smoking status. Results showed that current and former-smokers had significantly greater depressive symptoms than non-smokers. Ten percent of patients were taking antidepressants, most frequently SSRIs, with significantly more smokers on antidepressants than former and non-smokers. At follow-up, smokers on antidepressants were less likely to have quit, had greater anxiety, depressive symptoms and insomnia than smokers not using antidepressants. This study demonstrated that smokers and quitters with CAD had greater depressive symptoms and use of antidepressants than non-smokers, but that the antidepressants utilized may not be optimizing outcomes.
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Affiliation(s)
- Shannon Gravely-Witte
- Faculty of Health, York University, Norman Bethune 222B, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
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Leung YW, Ceccato N, Stewart DE, Grace SL. A prospective examination of patterns and correlates of exercise maintenance in coronary artery disease patients. J Behav Med 2007; 30:411-21. [PMID: 17616799 PMCID: PMC2924366 DOI: 10.1007/s10865-007-9117-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 05/17/2007] [Indexed: 11/28/2022]
Abstract
This longitudinal study examined exercise behavior patterns (i.e., maintainers, irregular, and inactive) in cardiac patients, and investigated the sociodemographic, clinical, psychosocial, and environmental correlates of exercise patterns. A total of 661 cardiac in-patients from three hospitals consented to participate (75% response rate) and were re-assessed 9 and 18 (81% retention) months post-discharge. Exercise patterns were assessed via the Health-Promoting Lifestyle Profile II subscale using a median split. Of 417 participants (mean age 63.1+/-10.2) with complete data, 42.2% were classified as Exercise Maintainers, 21.3% as Irregular Exercisers, and 26.1% as Inactive. Multinomial logistic regression revealed that Exercise Maintainers were more likely to be male, have exercised prior to their diagnosis, attend cardiac rehabilitation, perceive fewer exercise barriers, and were less likely to be current-smokers, past-smokers, or attribute the cause of their disease to their own behavior. Patients more likely to maintain exercise have positive perceptions and utilize cardiac rehabilitation.
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Affiliation(s)
- Yvonne W Leung
- Kinesiology and Health Science, 222A Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
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