Study Suggests Increased Risk of Mortality Following Heart Attack for Veterans Insufficiently Treated for Major Depressive Disorder
It is well established that depression following a myocardial infarction (MI) increases risk for mortality. Those at greatest risk may be patients with treatment-resistant depression; for example, those who fail to respond to a single trial of an antidepressant at adequate dose and duration, or those with simultaneous use of multiple antidepressants plus augmentation. This study sought to determine if mortality following acute MI was associated with treatment-resistant depression (TRD). Using VA data, investigators identified 536,415 Veterans (ages 25-80) free of diagnosed cardiovascular disease in FY99 and FY00, who’d had at least one VA outpatient visit in each year. Of this group, 96,612 also had a primary diagnosis of major depressive disorder (MDD). The entire patient cohort was followed from 10/00 through 9/07, resulting in 4,037 Veterans with MDD who suffered an MI during the 7-year follow-up period. The main outcome assessed was all-cause mortality; other variables included sociodemographics, comorbid disorders, beta blocker use, and healthcare use.
Findings show that all-cause mortality following an acute MI is greatest in Veterans with depression that is insufficiently treated – and is a risk in Veterans with treatment-resistant depression. Veterans who were insufficiently treated for MDD following an MI were 3.04 times more likely to die than those who received treatment. Veterans with TRD were 1.71 times more likely to die; however, this risk was partly explained by comorbid disorders. Among the 4,037 Veterans with MDD after an MI, 62% were successfully treated, 26% were insufficiently treated, and 12% had treatment-resistant depression. Insufficiently treated Veterans were more likely to be older, and treatment-resistant Veterans were more likely to be younger than treated patients. Alcohol abuse/dependence was more common in Veterans with TRD, as was having an anxiety disorder. Obesity also was more common in Veterans with TRD. Beta-blocker use was more common among Veterans who were treated for depression or had TRD. In addition, clinic visits per month were greatest among Veterans in the TRD group.
Scherrer J, Chrusciel T, Garfield L, et al. Insufficient treatment, treatment-resistant depression and all-cause mortality. The British Journal of Psychiatry January 12, 2012;e-pub ahead of print.
This study was supported by an HSR&D Career Development Award to Dr. Scherrer, who is part of the St. Louis VAMC.
