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To the editor:  In coronary heart disease (CHD) patients, depression is highly prevalent (1). Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line antidepressant treatments for this population (2,3). While there is a long-standing notion that SSRIs may improve cardiac prognosis by inhibiting platelet aggregation, SSRI use may also worsen prognosis by increasing bleeding (4), or arrhythmia risk (5).  Only a few small randomized clinical trials (RCTs) with a total of 801 patients have assessed the efficacy of SSRIs in patients with a cardiac condition (6,7). Although no evidence for harm was detected in two meta-analyses, the follow-up periods for adverse cardiac events in these RCTs did not extend beyond six months, and patient samples were highly selected (i.e. only patients not already receiving antidepressant therapy in usual care were included, and patients with comorbid conditions were excluded).  Accordingly, we evaluated, in an observational cohort of patients with acute coronary syndromes (ACS), the association of SSRI and non-SSRI second-generation antidepressant use with the occurrence of cardiac events and mortality across a period of 42 months.

Serotonin Reuptake Inhibitor Use, Depression, and Long-Term Outcomes After an Acute Coronary Syndrome: A Prospective Cohort Study