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| |  Fluoxetine May Help Older Depressed Patients With Severe Heart Ailments WASHINGTON, MD -- May 1, 1998 -- The results of the second in a series of studies, published today in the American Journal of Psychiatry, confirms that the newer selective serotonin-reuptake inhibitor (SSRI) antidepressants such as Prozac (fluoxetine) are safer than the older, commonly used tricyclics for treating patients with coexisting depression and heart disease. An estimated 20 percent of people with heart ailments develop major depression and the two diseases frequently coexist in older patients. "Heart disease is complicated and rehabilitation is often hindered in patients who have depression which goes undiagnosed and untreated," said Steven Roose, M.D., lead researcher on the study and a member of the American Association for Geriatric Psychiatry (AAGP). "It is possible that patients who are successfully treated for depression will be more active participants in their own rehabilitation from heart disease." Approximately six million older adults suffer from major depression and approximately one million older adults with depression are undiagnosed or untreated. Citing the high incidence of untreated depression among older adults, AAGP has called for depression screening as a routine part of elder medical care. "The findings are positive news for depressed patients who also suffer from heart ailments," said Dr. Roose, also a professor of clinical psychiatry at Columbia University and AAGP's lead researcher on heart disease and depression in late life. "The older tricyclic antidepressants have always been effective for the treatment of depression, but their cardiovascular toxicity has been a concern. Our latest study showed that fluoxetine appears to be a safer choice of medications for patients with heart disease." Older antidepressants, known as tricyclics, previously have been linked to troubling adverse events such as increased heart rate and orthostatic hypotension, which can lead to further heart complications and cardiac death. Although the SSRI class of antidepressants have been available in the United States for more than 10 years, until now little data have been available for patients and physicians regarding the impact of these medications on the heart. The most recent study examined 87 patients with severe depression and severe heart disease, including congestive heart failure, conduction disease and/or ventricular arrhythmia. Nearly three-quarters of the patients were men and the average age was 73. There were 27 patients given up to 60 milligrams of fluoxetine for up to seven weeks. Sixty patients in a comparison group were given nortriptyline, a tricyclic antidepressant. Researchers determined that fluoxetine -- the first SSRI antidepressant introduced more than 10 years ago -- was not associated with the cardiovascular effects that often are linked with tricyclic antidepressants. In fact, researchers determined that fluoxetine appeared to be a benign treatment in depressed patients with cardiac disease. Nortriptyline had a 20 percent rate of cardiac adverse events (12 of 60 patients) while just one of 27 fluoxetine patients (four percent) showed adverse cardiac events. "There still is not a tremendous amount of data on this issue but the data we do have is encouraging," Dr. Roose said. More information on: Prozac.
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