The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review

Article Details

Authors
Rebecca Hedrick MD, Samuel Korouri BA, Emile Tadros BS, Tarneem Darwish MD, Veronica Cortez RN, OD, Desiree Triay RN, Mia Pasini RN, MSN, Linda Olanisa LCSW, Nathalie Herrera MD, Sophia Hanna BA, MA, Asher Kimchi MD, Michele Hamilton MD, Itai Danovitch MD, MBA, Waguih William IsHak MD, FAPA

Article Type
Original Research

DOI
10.7573/dic.2020-5-4

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Abstract

Objective: The purpose of this paper is to review the literature on the impact of antidepressants on depressive symptom severity, quality of life (QoL), morbidity, and mortality in patients with heart failure (HF).

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published from December 1969 to December 2019 that pertain to depression and HF were identified through the use of the PubMed and PsycINFO databases, using the keywords: ‘antidepressant*’ and ‘heart failure.’ Two authors independently conducted a focused analysis and reached a final consensus on 17 studies that met the specific selection criteria and passed the study quality checks.

Results: Studies varied in types of antidepressants used as well as in study designs. Ten studies were analyzed for the impact of antidepressant medications on depressive symptom severity. Five of these were randomized controlled trials (RCTs), out of which sertraline and paroxetine showed a significant reduction in depressive symptoms despite the small samples utilized. Four of the 17 studies addressed QoL as part of their outcomes showing no difference for escitalopram (RCT), significantly greater improvements for paroxetine controlled release (RCT), statistical significance for sertraline compared to control (pilot study), and showing significant improvement before and after treatment (open-label trial) for nefazodone. Thirteen of the 17 studies included measures of morbidity and mortality. Although early analyses have pointed to an association of antidepressant use and mortality particularly with fluoxetine, the reviewed studies showed no increase in mortality for antidepressants, and secondary analyses showed improved mortality in patients who achieved remission of depressive symptoms.

Conclusion: Out of the various antidepressants studied, which included sertraline, paroxetine, escitalopram, citalopram, bupropion, nefazodone, and nortriptyline, selective serotonin reuptake inhibitors seem to be a safe treatment option for patients with depression and HF. However, due to the variety of study designs as well as the mixed results for each antidepressant, more information for reducing depression severity, morbidity, and mortality and improving quality of life in patients with HF should be examined using robust large sample RCTs.

Keywords: antidepressants, depression, heart failure, interventions, treatment.

Citation: Hedrick R, Korouri S, Tadros E, Darwish T, Cortez V, Triay D, Pasini M, Olanisa L, Herrera N, Hanna S, Kimchi A, Hamilton M, Danovitch I, IsHak WW. The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review. Drugs in Context 2020; 9: 2020-5-4. DOI: 10.7573/dic.2020-5-4

Contributions: Rebecca Hedrick, Samuel Korouri, and Waguih William IsHak contributed to writing the main body of the text. All other authors contributed equally to editing and finalizing the manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/06/dic.2020-5-4-COI.pdf

Acknowledgements: None.

Funding declaration: Research reported in this article was partially funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (2017C2-7716 – IsHak). Disclaimer: The statements presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.

Copyright: Copyright © 2020 Hedrick R, Korouri S, Tadros E, Darwish T, Cortez V, Triay D, Pasini M, Olanisa L, Herrera N, Hanna S, Kimchi A, Hamilton M, Danovitch I, IsHak WW. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Hedrick R, Korouri S, Tadros E, Darwish T, Cortez V, Triay D, Pasini M, Olanisa L, Herrera N, Hanna S, Kimchi A, Hamilton M, Danovitch I, IsHak WW. https://doi.org/10.7573/dic.2020-5-4. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/the-impact-of-antidepressants-on-depressive-symptom-severity,-quality-of-life,-morbidity,-and-mortality-in-heart-failure:-a-systematic-review

Correspondence: Waguih William IsHak, Department of Psychiatry & Behavioral Neurosciences, Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians, Suite E-132, Los Angeles, CA 90048, USA. Waguih.IsHak@cshs.org

Provenance: invited; externally peer reviewed.

Submitted: 8 May 2020; Peer review comments to author: 21 May 2020; Revised manuscript received: 5 June 2020; Accepted: 12 June 2020; Publication date: 29 July 2020.

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