Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction

Jeffrey F. Scherrer, Timothy Chrusciel, Lauren D. Garfield, Kenneth E. Freedland, Robert M. Carney, Paul Hauptman, Kathleen K. Bucholz, Richard Owen, Patrick J. Lustman

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression. Aims: We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression. Method: Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatmentresistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months. Results: During follow-up of 4037 patients with major depressive disorder who had had a myocardial infarction, 6.9% of those with insufficiently treated depression, 2.4% of those with treated depression and 5.0% of those with treatmentresistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95% CI 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95% CI 1.05-2.79) times more likely to die. Conclusions: All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.

Original languageEnglish (US)
Pages (from-to)137-142
Number of pages6
JournalBritish Journal of Psychiatry
Volume200
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Fingerprint

Myocardial Infarction
Depression
Treatment-Resistant Depressive Disorder
Mortality
Therapeutics
Antidepressive Agents
Electroconvulsive Therapy
Monoamine Oxidase Inhibitors
Major Depressive Disorder
Anxiety Disorders
Health Services
Survival

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

Cite this

Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction. / Scherrer, Jeffrey F.; Chrusciel, Timothy; Garfield, Lauren D.; Freedland, Kenneth E.; Carney, Robert M.; Hauptman, Paul; Bucholz, Kathleen K.; Owen, Richard; Lustman, Patrick J.

In: British Journal of Psychiatry, Vol. 200, No. 2, 01.02.2012, p. 137-142.

Research output: Contribution to journalArticle

Scherrer, JF, Chrusciel, T, Garfield, LD, Freedland, KE, Carney, RM, Hauptman, P, Bucholz, KK, Owen, R & Lustman, PJ 2012, 'Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction', British Journal of Psychiatry, vol. 200, no. 2, pp. 137-142. https://doi.org/10.1192/bjp.bp.111.096479
Scherrer, Jeffrey F. ; Chrusciel, Timothy ; Garfield, Lauren D. ; Freedland, Kenneth E. ; Carney, Robert M. ; Hauptman, Paul ; Bucholz, Kathleen K. ; Owen, Richard ; Lustman, Patrick J. / Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction. In: British Journal of Psychiatry. 2012 ; Vol. 200, No. 2. pp. 137-142.
@article{15693cc2c7d4413085f8c906adaf353a,
title = "Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction",
abstract = "Background: Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression. Aims: We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression. Method: Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatmentresistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months. Results: During follow-up of 4037 patients with major depressive disorder who had had a myocardial infarction, 6.9{\%} of those with insufficiently treated depression, 2.4{\%} of those with treated depression and 5.0{\%} of those with treatmentresistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95{\%} CI 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95{\%} CI 1.05-2.79) times more likely to die. Conclusions: All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.",
author = "Scherrer, {Jeffrey F.} and Timothy Chrusciel and Garfield, {Lauren D.} and Freedland, {Kenneth E.} and Carney, {Robert M.} and Paul Hauptman and Bucholz, {Kathleen K.} and Richard Owen and Lustman, {Patrick J.}",
year = "2012",
month = "2",
day = "1",
doi = "10.1192/bjp.bp.111.096479",
language = "English (US)",
volume = "200",
pages = "137--142",
journal = "British Journal of Psychiatry",
issn = "0007-1250",
publisher = "Royal College of Psychiatrists",
number = "2",

}

TY - JOUR

T1 - Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction

AU - Scherrer, Jeffrey F.

AU - Chrusciel, Timothy

AU - Garfield, Lauren D.

AU - Freedland, Kenneth E.

AU - Carney, Robert M.

AU - Hauptman, Paul

AU - Bucholz, Kathleen K.

AU - Owen, Richard

AU - Lustman, Patrick J.

PY - 2012/2/1

Y1 - 2012/2/1

N2 - Background: Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression. Aims: We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression. Method: Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatmentresistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months. Results: During follow-up of 4037 patients with major depressive disorder who had had a myocardial infarction, 6.9% of those with insufficiently treated depression, 2.4% of those with treated depression and 5.0% of those with treatmentresistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95% CI 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95% CI 1.05-2.79) times more likely to die. Conclusions: All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.

AB - Background: Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression. Aims: We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression. Method: Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatmentresistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months. Results: During follow-up of 4037 patients with major depressive disorder who had had a myocardial infarction, 6.9% of those with insufficiently treated depression, 2.4% of those with treated depression and 5.0% of those with treatmentresistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95% CI 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95% CI 1.05-2.79) times more likely to die. Conclusions: All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.

UR - http://www.scopus.com/inward/record.url?scp=84857094820&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857094820&partnerID=8YFLogxK

U2 - 10.1192/bjp.bp.111.096479

DO - 10.1192/bjp.bp.111.096479

M3 - Article

VL - 200

SP - 137

EP - 142

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

IS - 2

ER -