Serotonin Reuptake Inhibitor Use, Depression, and Long-Term Outcomes After an Acute Coronary Syndrome: A Prospective Cohort Study

Depression is highly prevalent among patients with coronary heart disease.1 Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line antidepressant treatments for this population.2,3 Whereas there is a long-standing notion that SSRIs may improve cardiac disease prognosis by inhibiting platelet aggregation, SSRI use may also worsen prognosis by increasing bleeding4 or increasing the risk for arrhythmia.5 Only a few small randomized clinical trials with a total of 801 patients have assessed the efficacy of SSRIs in patients with a cardiac condition.6,7 Although no evidence for harm was detected in 2 meta-analyses, the follow-up periods for adverse cardiac events in these trials did not extend beyond 6 months, and patient samples were highly selected (ie, only patients not already receiving antidepressant therapy in usual care were included, and patients with comorbid conditions were excluded). In a cohort of patients with acute coronary syndrome (ACS), we evaluated the association of SSRI and non-SSRI second-generation antidepressant use with the occurrence of cardiac events and mortality during a median follow-up period of 40 months.