Antidepressant helps prevent heart problems – Expert Q&A

A popular antidepressant has been shown to prevent further heart problems in people with depression and a history of heart disease.

People with depression are at greater risk of acute coronary syndrome – a term which includes heart attacks and angina. A Korean study published in JAMA has found people with both illnesses had fewer heart problems after being treated with the antidepressant escitalopram for 24 weeks. Escitalopram is commonly used to treat depression in New Zealand, and is very similar to the drug citalopram.

The SMC asked an expert to comment on the study. Please feel free to use these comments in your reporting. More information on the study is available on scimex.org – contact us if you’d like a copy of the study.


Dr Catherine Crofts, Lecturer, Pharmacology, AUT, and NZ-registered Pharmacist, comments:

What do you think are the most important findings in this research?
“The most important finding from this research is that using escitalopram for 24 weeks to treat depression in people who have just had an acute coronary event may improve health outcomes compared to using placebo or other antidepressants.”

Can you explain some of the science behind these results? Why was this particular antidepressant effective against heart events? 
“We cannot explain why this antidepressant (escitalopram) was successful in reducing the risk of a subsequent cardiovascular event. It does not appear to be a “class effect” as, in another study, sertraline (another member of the same SSRI class of medicines as escitalopram) showed no benefit in reducing mortality.”

What do you believe are the limitations of this study? 
“This study was conducted in a relatively small group of Korean people who were did not have severe cardiovascular disease. We don’t know if these results will apply to Europeans or any other ethnic groups or to people with severe cardiovascular disease.”

Have you seen this effect, or any similar effects, as a result of any other drugs used to treat depression? 
“Previous research has not shown these benefits when different antidepressant medications have been used. We know that relatively low doses of this medication were effective. This means that the cardiac health benefits may not be related to treating the depression.

However, we also know that depression can have negative effects on health, so treating depression can improve a number of health outcomes. There is another study in progress using a citalopram, which is a very similar medication to escitalopram. We need more research to better understand what has happened in this study.”

What do you think should be the upshot of this research?
“Escitalopram should be considered as the first-line treatment in people with depression following acute coronary syndrome. But more research is needed to understand the effects, especially in non-Korean people.”

How common is escitalopram in NZ for treating depression – is it the drug of choice?
“Citalopram and escitalopram are very common antidepressants used in New Zealand. Both of these drugs have a very similar chemical structure.”

Are there many serious side effects of escitalopram, and what are they?
“Major and serious adverse effects associated with these medicines are rare. Many people experience transient effects while starting these medicines that may include nausea or insomnia. But your doctor, prescriber, or pharmacist are the best people to talk to about any concerns you have about these medications. These medicines should not be stopped suddenly without medical advice.”

General comment: 
“In the context of this study, I would say this medicine should be considered first line treatment for treating depression following Acute Coronary Syndrome. Escitalopram is a good medicine to use for depression and if it has other cardiovascular benefits, then it is a very reasonable choice.

While there appears to be greater benefit to using escitalopram over other antidepressants, to treat depression following an acute coronary event, there is a lot we do not understand.”

No conflict of interest.