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SSRIs best antidepressants for heart disease patients

By Nigel Praities

SSRIs are the best choice for the treatment of depression in patients with heart disease, says an independent review of antidepressant treatments.

QOF indicators on depression screening in patients with heart disease and diabetes have attracted criticism from GPs, because of the lack of available evidence for choice of treatment.

But the new assessment strengthens the case for use of SSRIs, after recommending that despite limited clinical trial evidence the drugs should ‘probably' be considered first-line treatment in depressed patients with heart disease.

The review in the Drugs and Therapeutics Bulletin looked at clinical trials, observational studies and yellow card data, and found SSRIs were ‘relatively free' of unwanted cardiac effects and ‘should probably be tried first' in patients with heart disease.

Dr Ike Iheanacho, editor of the DTB, said it was important GPs avoided adverse cardiac effects in patients with heart disease as depression doubled their chances of cardiac death. ‘In most of the situations when a patient definitely needs an antidepressant you are going to be better off choosing an SSRI than some of the other kinds of drugs,' he said.

Dr Iheancho urged GPs to avoid treatments such as tricyclics and venlafaxine in patients with heart disease, as they were associated with arrhythmia and myocardial infarction.

Dr John Hague, a GP in Ipswich and mental health adviser to Suffolk PCT, said GPs could use this latest advice to help guide what drug they chose to prescribe, when discovering depression in patients with heart disease during screening. ‘It is very useful to have such clear, common-sense advice, which I am sure GPs will find useful,' he said.

NICE is currently developing a guideline for the treatment of depression in adults with chronic physical health problems, which will be released in 2009.

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