Efficacy and tolerability of antidepressants for treatment of depression in coronary artery disease: a meta-analysis
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Objective: Depression occurs in 18% to 45% of patients with coronary artery disease (CAD) where it is associated with an increased risk of acute coronary events and mortality. Our objective was to quantitatively summarize the data on the efficacy and tolerability of antidepressant (AD) treatment for depression in CAD. Methods: We performed a meta-analysis of randomized, placebo-controlled, double-blind trials with a database search of the English literature (to March 2008) and manual search of references. Results: Four clinical trials with ADs (mirtazapine, citalopram, fluoxetine, and sertraline) of a 9- to 24-week duration involving 798 subjects (402 ADs, 396 placebo) with documented CAD and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for depression were included. ADs were superior to placebo for decreasing Hamilton Depression Rating Scale (HDRS) scores (402 ADs, 396 placebo; weighted mean difference 1.41, 95% CI 0.53 to 2.29, P = 0.002) and Beck Depression Inventory (BDI) scores (373 ADs, 369 placebo; weighted mean difference 2.27, 95% CI 0.60 to 3.94, P = 0.008). The proportion of patients (216 ADs, 213 placebo) who responded (a 50% or more reduction in HDRS scores, OR 1.72, 95% CI 1.17 to 2.54) and remitted (HDRS of 8 or less at final assessment, OR 1.80, 95% CI 1.18 to 2.74), were also significantly higher with AD, compared with placebo, with no significant differences between the 2 groups for overall dropouts (OR 0.84, 95% CI 0.42 to 1.68) or dropout owing to adverse events (OR 1.30, 95% CI 0.75 to 2.25). The combined studies were homogeneous except for overall dropout rate ( P = 0.01). Conclusion: Treatment with ADs for depression in CAD results in significant therapeutic effects without substantially increased rates of discontinuation.
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Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy or SSRIs, but evidence for a beneficial effect on cardiac endpoints is inconclusive.
“Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy 84,85,351 -353 or selective serotonin re-uptake inhibitors, 354 -356 although evidence for a beneficial effect on cardiac endpoints is inconclusive.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [356]
Most studies showed no significant beneficial effect of treating depression on cardiac endpoints, but a recent RCT revealed fewer depressive symptoms and fewer major adverse cardiac events.
“Whereas most studies could show no significant beneficial effect, 84,351 -356 a recent RCT revealed fewer depressive symptoms as well as fewer major adverse cardiac events.85”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [356]
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Antidepressants and Risk of Sudden Cardiac Death: A Network Meta-Analysis and Systematic Review
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(2013) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378258 · Cited by 6 · see citing works
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Chapter 3. Communicating With Cancer Patients and Their Families
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The Role of Inflammation in Mediating Risk for Medical Disorders in Depressed Patients
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Chapter 7. Dimensional Psychopharmacology of the Cancer Patient
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Chapter 2. Cancer: A Family Affair
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Chapter 10. The Value of Quality of Life Assessment in Cancer Patients
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Chapter 5. Counseling and Specific Psychological Treatments in Common Clinical Settings: An Overview
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Transcriptional regulation by the mammalian stress-activated protein kinase p38
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Antidepressant drugs and cardio-vascular system
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Major Psychiatric Complications of Cardiac Surgery
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Traditional Herbal Medicines in Mood Disorders: A Promising Development Target
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Major Psychiatric Complications of Cardiac Surgery
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Depressive symptoms in rehabilitation post-spinal cord injury
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(2013) · Psycho-Oncology · doi:10.1176/appi.books.9781615378258.fm01
Chapter 1. The Crisis of Discovery: Psychological and Psychopathological Reaction to the Disease
Costantini, A., Levenson, J. A., & Bersani, F. S. (2013) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378258.lg01
Chapter 6. Genetic Counseling and Testing for Hereditary Cancers: Psychosocial Considerations
Burton-Chase, A. M., Gritz, E. R., & Peterson, S. K. (2013) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378258.lg06
Chapter 4. Demoralization and Depression in Cancer
Kissane, D. W., & Doolittle, M. N. (2013) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378258.lg04
(2013) · Psycho-Oncology · doi:10.1176/appi.books.9781615378258.index
Chapter 9. Rapid Psychometric Assessment of Distress and Depression
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Chapter 11. Support of the Dying Patient: Psychological Issues and Communication
Stiefel, F. (2013) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378258.lg11
Singh, K., Blostein, F., Wells, Q. S., Hodges, E. C., Cox, N. J., & Davis, L. K. (2025) · medRxiv · doi:10.1101/2025.10.13.25337946
- Authors
- Dowlati, Y., Herrmann, N., Swardfager, W. L., Reim, E. K., & Lanctôt, K. L.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Lanctôt, Krista L
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2010-02
- Volume
- 55
- Issue
- 2
- Pages
- 91-99
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- OpenAlex
- W172043770
- Cited by
- 79
- References
- 81
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 4 · 2015: 4 · 2014: 5 · 2013: 23 · 2012: 14
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Abbott Fund
- Abbott Laboratories
- Eli Lilly and Company
- Pfizer
- Physicians' Services Incorporated Foundation
- H. Lundbeck A/S
- Lundbeck Canada
- Pfizer Canada
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- antidepressants, depression, coronary artery disease, mirtazapine, citalopram, fluoxetine, sertraline, antidepressant efficacy, antidepressant tolerability, treatment response and remission, adverse events, dropout, placebo comparison, cancer-related depression
- MeSH terms
- Antidepressive Agents, Coronary Artery Disease, Depression, Double-Blind Method, Humans, Patient Dropouts, Psychiatric Status Rating Scales, Randomized Controlled Trials as Topic, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders
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