Furious Seasons

March 10, 2009

Major Study: Depression, Anti-Depressants Linked To Women's Sudden Cardiac Death

A new round of the so-called Nurse's Health Study of women--a long-term, multiple measures of women's health that included tens of thousands of women--hit the news yesterday. The principle takeaway is that researchers found a link to depression and sudden cardiac death (aka, heart attack) in women. Researchers also found an association between sudden cardiac death and anti-depressant use in women. The study was published in the Journal of the American College of Cardiology and while I don't have access to the full study, here's how researchers put their conclusion in the abstract:

"In this cohort of women without baseline CHD, depressive symptoms were associated with fatal CHD [coronary heart disease], and a measure of clinical depression including antidepressant use was specifically associated with SCD [sudden cardiac death]. Although antidepressant use might be a marker of worse depression, its specific association with SCD merits further study."

This was found to be true among a group of over 63,000 women, so this wasn't a small scale study. While I'm not surprised by the link between depression and sudden cardiac death, I must admit to being somewhat bowled over by the anti-depressant link. The study authors and others in the media were quick to try and defend anti-depressnt use.

From Medscape (via Beyond Meds):

"But the authors and accompanying editorialists conclude that, at the present time, the benefits of appropriately prescribed antidepressant use likely outweigh the risk of SCD."

From MSNBC.com:

"Studies of the newer antidepressants most often used today so far haven't signaled a risk of irregular heartbeat, and some even have suggested protection, noted Dr. Redford Williams of Duke University, a specialist in how psychosocial factors affect health.
"The drug question aside, Williams said the work adds to growing evidence that depression is an independent risk factor for heart disease — on top of the classic risks of high blood pressure, diabetes, high cholesterol and smoking."

Protection? What study would that be? MSNBC doesn't say.

Meanwhile, NBC's "Nightly News" gave the depression and cardiac death link huge play on its program last evening, but Brian Williams, the show's anchor, completely failed to mention the anti-depressant link. I'm not sure who is writing Williams' copy, but either they or he are utterly blind to not mention that point. Or is the TV media too scared of being dinged for allegedly scaring people off their meds?

All that aside, most studies of anti-depressants and sudden cardiac death have found the problem to exist mostly with older tricyclics, with some amount of risk found in SSRIs, as in this 2004 study. While there would be obvious questions in the new study about what anti-depressants the women were taking and for how long, there is certainly evidence that newish anti-depressants like Effexor and Effexor XR can raise patients' blood pressure, potentially a clue to researchers looking to do further study. In fact the Effexor XR website notes:

"EFFEXOR XR may raise blood pressure in some patients. Your blood pressure should be controlled before starting treatment and should be monitored regularly."

It'll be interesting to see what developments come out of the new paper and what further evidence pops up.

And for anyone in medicine who thinks that maybe they ought to just shift their female patients to atypical antipsychotics and use them to treat depression, they may want to read this study from the New England Journal of Medicine showing a 200 percent increase in sudden cardiac death in patients who take atypicals. And then there's the weight gain, the diabetes, the boosted cholesterol, the increased lipids, the altered Q-T rhythms, the...well, you know.

Two final points: over the last few years supposedly safe and beneficial anti-depressants have been taking huge hits over suicide, suicidality, mania induction in some people, birth defects, making people act oddly and for their makers overstating their efficacy, so why do doctors keep acting like they are so safe and that "more study" is needed to establish their risks? Please. We already know they are risky drugs.

Two, where is the long-term study of men's health and anti-depressant use?

Posted by Philip Dawdy at March 10, 2009 12:07 AM

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Comments

What's interesting, is that heart attacks kill women more often, because women and doctors don't know to watch for the signs of heart attack, which are often different than men's.

Cardiac health, in general is overlooked with regard to women.

The alarming thing is, many women are prescribed Prozac, Lexapro, etc. for "menopause". I know several women who came away from a PCP appt. with an anti depressant for supposed hormonal problems.

This, segways into women being dx with depression and now being rx'd antipsychotics, such as Abilify and Seroquel. There's another entire risk category to threat of a woman's health.(as mentioned in this article)

I feel many women do not understand their body, (how stress, caregiving, working/parenting full time,etc)and what can affect their health, and high blood pressure is a side effect of most any drug, not to mention birth control pills and blood clots adding to a mix of possible med cocktails.

All of that considered, it's an eye opening study that I hope psychiatrists and PCP's pay attention to, because so often, women are rx'ed psych meds and not monitored medically afterward.

I had my PCP start monitoring (weekly at one point) my heart when I was under severe strain while filing for, and having to attend bankruptcy court. The PCP was very concerned over the stress and the (extreme)high blood pressure that situation was causing; while my psychiatrist offered me Lexapro.

I declined the Lexapro, and don't regret it.

Posted by: Stephany at March 10, 2009 01:39 AM

There has been a pretty good amount of research looking at the effect of antidepressants on heart performance parameters. I haven't looked at this in a couple years. But nothing was alarming from that early, big effort. So, I believe Redford is on decent ground to say that antidepressants themselves are not a big risk for heart attack or heart disease generally.

My guess is that the antidepressants simply did not work very well for the depression.

Posted by: MedsVsTherapy at March 10, 2009 06:02 AM

I'm imagining there isn't much data on men since most of these studies draw from the same nurses group, which is composed of mostly women. There doesn't seem to be a comparable group of men unfortunately. I'm not sure what the ratio of women to men is in the nursing field? 20 to 1? That would still leave 3000 men.

Posted by: Brian at March 10, 2009 11:08 AM

Back in 1998, I emailed a list of the side-effects listed in the very first Prozac insert. I just now found it in my "Saved" box for early Prozac messages. Here is what was in the original Prozac insert in regard to cardiovascular adverse reactions.

BTW, I called Eli Lilly in regard to "hemorrahage" listed as Frequent under cardiovascular side effects. I was given the run around and never obtained an answer as to what this meant.

Cardiovascular System ---Frequent: hemorrhage, hypertension: Infrequent:
> angina pectoris, arrhythmia, congestive heart failure, hypotension,
> migraine, myocardial infarct, postural hypotension, syncope, tachycardia,
> vascular headache: Rare: atrial fibrillation, bradycardia, cerebral
> embolism, cerebral ischemia, cerebrovascular accident, extrasystoles,
heart arrest, heart block, pallor, peripheral vascular disorder, phlebitis,
> shock, thrombophlebitis, thrombosis, vasospasm, ventricular arrhythmia,
> ventricular extrasystoles, ventricular fibrillation.
>

Posted by: Rosie at March 10, 2009 12:39 PM

Thanks for posting this.

I'm particularly interested in Stephany's response (3/10, 1:39am) of the increasing number of women taking anti-depressants for menopause -- if, in fact, SSRIs do increase risk for SCD, this could be significant for therapists to assess at intake.

And, to Phil's last paragraph, you're right, how many more studies do we need to "show" these drugs are "risky"? I mean, since when did mind-altering drugs get an "innocent until proven guilty" stamp?

Posted by: Zachary Taylor at March 10, 2009 01:29 PM

I DON'T think this can simply be explained by depression being a risk factor for heart disease (although it is) and the antidepressants simply not working very well. The study is fairly clear that one particular condition (irregular heartbeat) and one particular variable (antidepressant use) stand out.

And yes, it's alarming that antidepressants are more & more being prescribed for menopause. In fact, Effexor was specifically studied for relief of hot flashes (in women without depression) and proclaimed "safe and effective."

Posted by: Johanna at March 11, 2009 06:38 AM