Project Summary

Alexander H. Glassman, M.D. (Distinguished Investigator 2005) of Columbia University, notes that two studies suggest SSRI treatment of major depression reduces mortality after a heart attack. Past studies suggest that SSRIs reduce depression-associated mortality. One study found that a 30-month mortality was cut in half among patients who received SSRIs. A longer follow-up period increases the number of events and if treatment alters mortality, increases the chance of seeing the effect. Building on these studies, Dr. Glassman will conduct a National Death Index (NDI) search for deaths that have occurred since the first study was concluded in December, 1999. Depression unequivocally increases post Ml mortality. He believes that adding to the evidence that antidepressant treatment reduces mortality will increase pressure for NIH to fund a definitive trial. He also believes such a trial is crucial to psychiatry, not only because it could save approximately 4,000 lives every year, but because it would establish unequivocally that treating depression reduces mortality and would make an evaluation for depression a "standard of care" after Ml as it is now for myocardial ischemia, arrhythmia, or heart failure. Dr. Glassman points out that finding that antidepressant therapy reduces death will alter the stigma that both physicians and patients attach to psychiatric illness because it makes depression irrefutably a medical as well as a psychological condition. Additionally, it will help clarify which subsets of depressed patients are really at risk. Existing data suggests the excess mortality is primarily sudden death and is predicted by extra ventricular beats. This among other hypotheses will also be tested and if true, will identify a subgroup of post-MI depressed patients who are at extremely high risk for death and in urgent need of treatment.

Program Area: MOOD DISORDER\Unipolar Depression

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