Management of depression or anxiety disorder in coronary heart disease

Abstract

Depression or anxiety disorder (depression/anxiety) in coronary heart disease (CHD) promotes thrombogenesis, atherogenesis, and arrhythmogenesis. Elimination of depression/anxiety as a risk factor has therefore become a new target of antidepressant therapy in CHD. Pathogenesis-oriented laboratory and clinical trials have shown that the use of selective serotonin reuptake inhibitors (SSRI) paroxetine and serixaline after a previous myocardial infarction and upon CHD compensation reduces the risk for thrombogenesis, atherogenesis, and arrhythmogenesis. Treatment with an antidepressant (paroxetin, sertraline, fluoxetine) likewise reduced cardiovascular morbidity and mortality in two clinical trials including myocardial infarction survivors. The Dutch MIND-IT trial focusing on patients after a myocardial infarction treated with mirtazapine, and the Czech PrevenPar trial enrolling unselected CHD patients, treated by general practitioners with paroxetine, have consistently shown that patients with symptoms of severe and moderate depression persisting at 6 months (non-responders) show an increased incidence of serious cardiovascular complications during follow-up. The risk of complications declines as psychiatric symptoms resolve. In the PrevenPar trial, treatment with paroxetine eliminated symptoms of severe and moderate depression and improved the quality of life of patients within a year.