Antidepressant No Help to Heart Failure Patients
Depression in these cases may be caused by biological changes from the disease itself, researcher says
By Steven Reinberg
HealthDay Reporter
TUESDAY, June 28, 2016 (HealthDay News) -- The antidepressant Lexapro may not help heart failure patients suffering from depression, German researchers report.
"Depression in heart failure may not be the same depression patients without heart failure get and who respond well to antidepressants," said lead researcher Dr. Christiane Angermann, a professor of cardiology at University Hospital Wurzburg.
Heart failure is associated with biological changes that also cause depressive symptoms, she explained, "so it might be that an antidepressant is not the right drug to treat this depression." Heart failure occurs when the heart is weakened and cannot pump enough blood to meet the body's needs.
Among patients suffering from heart failure, 10 percent to 40 percent suffer from depression. Depression among these patients is an independent predictor of death and hospitalization, Angermann said.
Lexapro is part of the drug family called selective serotonin reuptake inhibitors (SSRIs). They're the most widely used antidepressants in the general population, but it hasn't been clear if they work in patients with heart failure, she added.
Angermann said that treating heart failure can help relieve depression. "When we treat the heart failure very well, depression improves," she said. "It may be that improving the systemic disorder heart failure takes away some of these depressive symptoms."
Antidepressants may just not be the right medications for heart failure patients, Angermann added, since other trials using the antidepressants Zoloft (another SSRI) and Remeron also showed no benefit.
"The sicker you are, the more inflammation you have in your body, the less you may respond to an antidepressant that addresses the depression rather than your illness -- that's our speculation," she said.
Although antidepressants may not be the best treatment for depression in patients with heart failure, other approaches might be worth trying, Angermann said.
"A good approach to the management of depressed heart failure patients could be to combine classical disease management strategies to optimize heart failure therapy, possibly in combination with cognitive behavioral therapy and physical exercise," she said.
For the study, Angermann and her colleagues randomly assigned 372 patients with chronic heart failure and depression to Lexapro (escitalopram) or a placebo in addition to heart failure treatments.
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