Peter D. Kramer Profile picture
Jul 25, 2018 7 tweets 3 min read Twitter logo Read on Twitter
1/ Important study on #antidepressants & #heartdisease. 6 months of Rx for even minor depression in #cardiac patients offers protection against adverse events (heart attack, death, etc) seen for many (8+) years out. @JAMA_current # of interesting points...
2/ The effects of meds on mood were the same as those in many other studies, 2-3 points difference on symptoms, NNT to remission between 5 & 6, effect size under .4 …& this difference, often dismissed as minor, was associated with marked benefits in terms of overall health...
3/ it looks as if treating about 10 patients early on prevents one heart attack, w & other benefits for heart (& overall) health. Benefits were larger in those whose mood disorder remitted & those who completed the trial. So: good news. Brief inexpensive Rx w lasting benefits...
4/ Contrary to what you might read in the press, pretty clearly it is possible to come off the meds. In the follow-up, only a handful of patients were on antidepressants (& some of them had gone through the trial on placebo)...
5/ In broad terms, the results resemble those for stroke survivors (I discuss a few of the neurology studies in #OrdinarilyWell.) Interesting question whether the main effects are all brain effects—seems likely—translated into heart health. #SSRIs also have blood-thinning effects
6/ My guess is that the modest depression-rating-scale effects represent larger effects on mood & mood stability that might be picked up in tighter scales like the HAM-D6 that look at core depressive symptoms.
7/ The number-needed-to-treat perspective is informative. Set aside effects on depression. For a depressed cardiac patients, escitalopram looks to be a better cardiac drug than a statin. The statin has to be taken indefinitely, for many years, & is likely to prevent fewer events.

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