Background: Depression following myocardial infarction is associated with poor cardiac prognosis. It is unclear whether antidepressant treatment improves long-term depression status and cardiac prognosis. Aims: To evaluate the effects of antidepressant treatment compared with usual care in an effectiveness study. Method: In a multicentre randomised controlled trial, 2177 myocardial infarction patients were evaluated for ICD-10 depression and randomised to intervention (n=209) or care as usual (n=122). Both arms were evaluated at 18 months post-myocardial infarction for long-term depression status and new cardiac events. Results: No differences were observed between intervention and control groups in mean scores on the Beck Depression Inventory (11.0, s.d.=7.5 v. 10.2, s.d.=5.1, P=0.45) or presence of ICD-10 depression (30.5 v. 32.1%, P=0.68).The cardiac event rate was 14% among the intervention group and 13% among controls (OR=1.07,95% CI 0.57-2.00). Conclusions: Antidepressant treatment did not alter long-term depression post-myocardial infarction status or improve cardiac prognosis.
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