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Depression in Heart Patients: Insights About Drug Adherence

. . . to both cardiac and antidepressant medications

Depression independently predicts adverse outcomes in patients with heart disease. Potential mediators are biologic factors such as the neurohormonal activation that characterizes depression and nonadherence to heart medications. We also don’t fully understand the influence of treating depression on cardiovascular outcomes. Two studies addressed these issues.

One was a cross-sectional study of 940 outpatients with documented coronary artery disease (22% with major depression) that evaluated the relation between the presence and severity of depression (according to the Patient Health Questionnaire) and adherence to heart medications. Self-reported nonadherence to heart medications was significantly more common in depressed than in nondepressed patients (about 10% vs. 5%), with the greatest nonadherence rates among the severely depressed (14%). Depression remained an independent correlate of nonadherence after adjustment for a wide range of patient characteristics.

In the other study, researchers used a large managed care database to identify patients receiving a new antidepressant drug prescription within a 2-year period and assessed adherence to medications for comorbid conditions both before and after the initiation of antidepressant therapy. Among patients with coronary artery disease or dyslipidemia, adherence to antidepressant therapy was associated with a significantly higher likelihood of adherence to statin therapy (odds ratio, 2.13) and with 17% lower disease-specific costs, after adjustment for potential confounders. Findings were similar among patients with diabetes.

Comment: Neither of these studies was designed to assess causal relationships, but they provide plausible evidence that depression might contribute to nonadherence to heart-medication regimens and that adherence to antidepressant therapy might improve adherence to cardiac drug therapy. Overall, the data bolster the case for depression screening and treatment in patients with heart disease.

— Frederick A. Masoudi, MD, MSPH

Published in Journal Watch Cardiology December 23, 2005

Citation(s):

Gehi A et al. Depression and medication adherence in outpatients with coronary heart disease: Findings from the Heart and Soul Study. Arch Intern Med 2005 Nov 28; 165:2508-13.

• Original article (Subscription may be required)
• Medline abstract (Free)

Katon W et al. Impact of antidepressant drug adherence on comorbid medication use and resource utilization. Arch Intern Med 2005 Nov 28; 165:2497-503.

• Original article (Subscription may be required)
• Medline abstract (Free)