Depression treatment with selective serotonin reuptake inhibitors for the postacute coronary syndrome population: a literature review.

OBJECTIVE: After acute coronary syndrome (ACS), patients have a significantly higher incidence of depression compared to the average healthy adult. Depression is independently associated with poorer outcomes and heightens the morbidity and mortality risk in this susceptible population. Selective serotonin reuptake inhibitors (SSRIs) are a newer class of antidepressants recently investigated for use in this population. This article reviews the current research on the safety, efficacy, possible benefits, and limitations of this class of antidepressants for patients with post-ACS. DATA SOURCES: Information was obtained through a literature search of the electronic databases CINAHL, EMBASE, Ovid Medline (R), and PubMed Plus during the months of January and February of 2007. Keywords searched included acute coronary syndrome, myocardial infarction, selective serotonin reuptake inhibitors, sertraline, paroxetine, fluoxetine, depressive disorder, major depression, and depression. Results were then limited to the English language, adult population, publication years 2002-2007, and primary research articles. The search was broadened to include years 2000-2002. STUDY SELECTION: Abstracts were reviewed for applicability. All studies meeting the criteria for research articles of SSRI use in depressed patients with post-ACS were included. This amounted to 6 articles. DATA EXTRACTION: Independent extraction was conducted by a single observer.
CONCLUSIONS: Recent research shows positive outcomes associated with the use of SSRIs for depressed patients with post-ACS. The greatest benefit from these medications appears to be in the recurrently and severely depressed subpopulations. Although the use of SSRIs in patients with post-ACS appears to be associated with a decrease in morbidity and mortality rates, large, randomized control trials are still needed to support this finding.