Depression and social isolation can increase the risk of heart attack. So researchers from Washington University’s School of Medicine, the Mayo Clinic, the Harvard School of Public Health and other centers around the United States wanted to learn whether they could lower the risk by treating depression. However, so far, as Jim Dryden reports, they have been unable to do that.
About 25 percent of all heart attack patients suffer either from depression or from social isolation, so the large, multicenter study called Enhancing Recovery in Coronary Heart Disease Patients, or ENRICHD, looked at more than 2400 depressed heart attack patients. The researchers enrolled the patients in the study within 28 days of a first heart attack and then divided the patients into two groups.
“Either they received the intervention – which included a psychotherapeutic intervention as well as the possibility of an antidepressant, or patients received usual medical care, without any special kind of intervention for their depression or social isolation.
That is Washington University psychologist Robert Carney, one of the led investigators of the national study. The ENRICHD study followed patients for 29 months, but at the end of that time, Carney and col-leagues found that the interventions for depression and social isolation had not changed the risks of future problems.
“There was no difference between the intervention and the usual care group in terms of survival, the rate of survival in the months following the heart attack.”
Carney says patients who received psychotherapy and interventions for social isolation did report that they felt better and that their quality of life had improved.
“There was a difference between the intervention and usual care in the level of depression over the six months following the heart attack, as well as a reduction in social isolation. But there was no impact on survival.”
Carney says he had hoped for a different outcome.
“The study was certainly a disappointment to us. It was a long time in the planning, and it took a long time to execute. And we were all hoping, of course, for a more desirable outcome. However, I think there are a number of things that we have learned from this study, and our hope at this point is to try to improve upon the intervention, design a more effective treatment for depression and social isolation and to try a second clinical trial, sometime in the not to distant future.”
One thing that study might examine is whether antidepressant drugs might be more effective than psycho-therapy at preventing future heart attacks. Carney says there is a hint in the ENRICHD study that the drugs might be beneficial.
“Those patients who either we provided the drug to or got it on their own, as in the usual case, did have a better rate of survival than the patients who were not on an antidepressant. You know, we are all a little bit concerned about people walking away with the idea that if they just take an antidepressant that that is going to do it for them. It may, but we don’t know because that requires a perspective study. The patients were not randomly assigned to receive the antidepressant. They received it if they did not respond to psychotherapy or if their doctors decided they should have one. So if you go back and look at those data, that relationship is there, but it is very difficult to interpret under the circumstances.”
The results of the ENRICHD study were reported last month in the Journal of the American Medical Association. I’m Jim Dryden