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Treatment-Resistant Depression and Mortality After Acute Coronary Syndrome
Open accessAbstract
Depression is a risk factor for morbidity and mortality in patients with coronary heart disease, especially following acute coronary syndrome. Evidence from recent clinical trials suggests that treatment-resistant depression may be associated with a particularly high risk of mortality or cardiac morbidity in patients following acute coronary syndrome. This article reviews this evidence and considers possible explanations for this relationship. Directions for future research are also considered, with particular emphasis on efforts to elucidate the underlying mechanisms and to develop more efficacious treatments for depression in patients with coronary heart disease.
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“Although there are conflicting data on the cardiovascular benefits of antidepressants in patients with CVD, a synthesis of data from numerous intervention trials found that unsuccessful treatment of depression after hospitalization for ACS is linked to elevated risk of mortality and cardiac events. 183”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [183]
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Schoepf, D. (2013) · InTech eBooks · doi:10.5772/2039 · Cited by 6
“Meta-analytic data have shown that depression increases one’s risk to develop CVD (Nicholson et al. 2006; Van der Kooy et al. 2007) and to have an unfavourable course of CVD with more cardiac events and higher mortality rates (Nicholson et al. 2006) (see paragraph 2.1).”
BackgroundInfluentialReply to Letter to the Editor: Treatment-Resistant Depression and Sudden Cardiac Death
Carney, R., & Freedland, K. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.03.081 · Cited by 8
Self-citationDepression treatment and coronary artery disease outcomes: Time for reflection
Shapiro, P. A. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.11.008 · Cited by 6
Definition and Epidemiology of Treatment Resistance in Psychiatry
Smith-Apeldoorn, S. Y., Veraart, J. K. E., & Schoevers, R. A. (2018) · Springer eBooks · doi:10.1007/978-981-10-4358-1_1 · Cited by 8
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Paolini, M., Maccario, M., Saredi, V., Verri, A., Calesella, F., Raffaelli, L., Lorenzi, C., Spadini, S., Zanardi, R., Colombo, C., et al. (2025) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13793 · Cited by 5
“…compared with treatment-sensitive ones [7–9] as well as a higher prevalence of cardiovascular risk factors, such as systemic autoimmune diseases and diabetes [9, 10], while the presence of TRD appears to be associated with poorer prognosis and higher mortality in coronary heart disease [11].”
Arendt, I. T. P., Gondan, M., Juul, S., Hastrup, L. H., Hjorthøj, C. R., Bach, B., Videbech, P., Jørgensen, M. B., & Møeller, S. B. (2024) · Trials · doi:10.1186/s13063-024-08079-9 · Cited by 9
“Conse - quences of DTD for the individual include increased suicidal risk as well as non-suicidal mortality (e.g. increased risk of coronary disease), compared to patients with non-chronic MDD [11, 12].”
Civardi, S. C., Besana, F., Miacca, G. C., Mazzoni, F., Arienti, V., Politi, P., Brondino, N., & Olivola, M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1371139 · Cited by 9
“Several studies have reported that TRD could be associated with increased mortality (8, 9), although the sample sizes were small and follow-up times have been relatively short.”
BackgroundMichal, M., Eggebrecht, L., Göbel, S., Panova‐Noeva, M., Nagler, M., Arnold, N., Lauterbach, M., Bickel, C., Wiltink, J., Beutel, M. E., et al. (2020) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvz085 · Cited by 5
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“For example, research has shown that depression is a significant and independent risk factor for cardiac morbidity and mortality following a cardiac event (10) and is associated with increased functional disability both at one yr and 5–10 yr post-transplant (11, 12).”
BackgroundBDNF, A Focus to Major Depression
de Nazareth, A. M. (2021) · Trends journal of sciences research · doi:10.31586/ojp.2021.161 · Cited by 23
“And it is predicted that this pathology, which is associated with morbidity and mortality [1-3], will become the first leading cause of disability and disease spending in developed countries until 2030 [4].”
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“Patients with treatmentresistant depression and Cardiovascular Disease (CVD) have a higher rate of cardiovascular events than those with less severe depression [30], and sleep researchers have wondered whether this is explained in part by the underlying inflammatory cascade from incipient OSA that characterizes all th…”
BackgroundDepression and Cardiovascular Disease Progression: Epidemiology, Mechanisms and Treatment
Hoen, P. W., Kupper, N. H. M., & de Jonge, P. (2011) · Springer eBooks · doi:10.1007/978-1-84882-419-5_12 · Cited by 3
Depression, Vascular Conditions and Chronicity
Seldenrijk, A., Vogelzangs, N., van Oppen, P., Penninx, B. W. J. H., & van, A. B. (2013) · InTech eBooks · doi:10.5772/51623 · Cited by 4
“In addition, (Carney & Freedland, 2009) have reviewed the literature in order to identify subtypes of depression which are associated with the highest risk of cardiac events in coronary heart patients.”
BackgroundDepression and coronary heart disease
Hare, D. L. (2011) · Elsevier eBooks · doi:10.1016/b978-0-7295-3927-2.10088-0 · Cited by 9
Neuropsychiatric Disease and Treatment
(2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt · Cited by 1,177
Xiao, J., Dong, X., Ding, M., Yang, Q., & Kong, T. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1518255 · Cited by 2
Feasibility of Integrating MEditatioN inTO heaRt Disease (the MENTOR Study)
Rao, A., Zecchin, R. P., Newton, P. J., Read, S. A., Phillips, J. L., DiGiacomo, M. L., Chang, S., Denniss, A. R., & Hickman, L. (2023) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000997 · Cited by 2
“15),(13) and between 20% and 35% of patients with depression are considered treatment resistant.(14) In primary care, public mental health, and psychiatry clinic settings, cognitive behavioral therapy when used alone or combined with antidepressant augmentation has demonstrated superiority over antidepressant augmenta…”
BackgroundCastro, M. N., Vigo, D. E., Gustafson, D., Vila-Pérez, I., Massaro, P., García, C., Nemeroff, C. B., Guinjoan, S. M., & Ladrón-de-Guevara, M. S. (2017) · Personalized Medicine in Psychiatry · doi:10.1016/j.pmip.2017.06.001 · Cited by 4
Sowden, G., Mastromauro, C. A., Seabrook, R. C., Celano, C., Rollman, B., & Huffman, J. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.05.019 · Cited by 2
Young Male Homicide Offenders and Victims: Current Knowledge, Beliefs, and Key Questions
Loeber, R., & Farrington, D. (2011) · Springer eBooks · doi:10.1007/978-1-4419-9949-8_1 · Cited by 2
Risk of major adverse cardiovascular events in treatment-resistant or severe depression
Nygren, A., Reutfors, J., Karlsson, P., Tiger, M., Faxén, J., & Brenner, P. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119419 · Cited by 1
Carney, R. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319845122 · Cited by 1
Self-citationLiang, F., Ma, X.-H., Zhao, L.-Z., Xing, C.-W., Li, X., Zhao, D.-J., Hu, D., Hu, S.-Q., Wang, W.-B., Han, L.-T., et al. (2017) · Cardiovascular Innovations and Applications · doi:10.15212/cvia.2017.0011 · Cited by 1
Williams, W., Kunik, M. E., Springer, J. R., & Graham, D. P. (2013) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000438186.59112.72
Rnic, K., & Dozois, D. (2020) · The Wiley Encyclopedia of Personality and Individual Differences · doi:10.1002/9781119547174.ch197
“When a medical condition co- occurs with depression, the course of the medical condition is often longer, and the condition may complicate treatments for depression (Carney & Freedland, 2017; Freedland & Carney, 2009).”
BackgroundThe challenge of risk stratification and prevention in athletes
Piepoli, M. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319870638
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Michal, M., Münzel, T. F., & Beutel, M. E. (2011) · Psychiatrie und Psychotherapie up2date · doi:10.1055/s-0031-1276852
More aggressive treatment for depression?
Nicholas, J. R. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09040520
Depression Levels Following Discharge Predict Quality of Life in Heart Disease Patients
Lemos, M., Román-Calderón, J. P., Rios, P. C., Torres, S. R., & Agudelo, D. (2019) · Psicologia: Teoria e Pesquisa · doi:10.1590/0102.3772e35443
Pelletier, R., Ditto, B., Lavoie, K., Karp, I., Bacon, S., Cox, J., Eisenberg, M., Daskalopoulou, S., Khan, N., Humphries, K., et al. (2017) · doi:10.4172/2572-0791.1000127
Anxiety and the Effects on Cardiovascular Disease
Tully, P. J., & Baune, B. T. (2016) · Springer eBooks · doi:10.1007/978-3-319-32480-7_5 · Cited by 1
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Akcakaya, R. L. R. (2012) · Open Scholarship Institutional Repository (Washington University in St. Louis) · doi:10.7936/k7bc3wp0
Bounhoure, J. (2010) · Elsevier eBooks · doi:10.1016/b978-2-294-70834-3.00007-6 · Cited by 1
International Journal of Women's Health
DiBonaventura, M. D., Chandran, A., Hsu, M.-A., & Bushmakin, A. (2020) · International Journal of Women s Health · doi:10.2147/ijwh
Metadata
- Authors
- Carney, R. M., & Freedland, K. E.
- Affiliations
- Washington University in St. Louis (US)
- Venue
- American Journal of Psychiatry
- Published
- 2009-04
- Volume
- 166
- Issue
- 4
- Pages
- 410-417
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3465939
- OpenAlex
- W2129412441
- Cited by
- 163
- References
- 62
- Citations by year
- 2025: 3 · 2024: 11 · 2023: 3 · 2022: 4 · 2021: 6 · 2020: 6 · 2019: 8 · 2018: 6 · 2017: 7 · 2016: 10 · 2015: 5 · 2014: 5 · 2013: 17 · 2012: 14
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL076808, HL-76808)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- treatment-resistant depression, acute coronary syndrome, mortality, coronary artery disease, cardiac morbidity, depression as risk factor
- MeSH terms
- Antidepressive Agents, Combined Modality Therapy, Depressive Disorder, Major, Major Depressive Disorder, Drug Resistance, Drug Therapy, Combination, Follow-Up Studies, Humans, Myocardial Infarction, Personality Inventory, Psychometrics, Citalopram, Comorbidity, Cognitive Behavioral Therapy, Survival Rate, Randomized Controlled Trials as Topic, Bupropion, Acute Coronary Syndrome, Secondary Prevention
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