Efficacy and safety of antidepressant in post-myocardial infarction associated depression: a meta-analysis and systematic review.

Abstract

Objective: This study aimed to summarize the available data and assess whether antidepressants are effective and well-tolerated in the treatment of post-myocardial infarction (MI)-associated depression.

Materials and methods: A comprehensive search of public databases (PubMed, Embase, Web of Science, Ovid, EBSCO, and the Cochrane Library) was conducted for publications on interventions for post-MI depression before October 2024. Keywords included post-myocardial infarction depression, antidepressants, myocardial infarction, and depression. Pooled data were analyzed using Stata software.

Results: A total of twelve studies were included. At baseline, no significant difference was observed in depression severity between the antidepressant treatment and control groups (pooled SMD = -0.022, 95% CI: -0.087-0.044). Antidepressant treatment significantly reduced depression scores after long-term follow-up (pooled SMD = -1.023, 95% CI: -1.671- -0.375). The incidence of adverse cardiac events was not significantly higher in the treatment group compared to the control group (pooled HR = 0.893, 95% CI: 0.793-1.005). Antidepressants did not increase the risk of all-cause mortality (pooled HR = 0.957, 95% CI: 0.699-1.311), and there was no significant difference in the risk of rehospitalization for heart disease (pooled HR = 1.070, 95% CI: 0.820-1.398). Antidepressant treatment was associated with a reduced risk of MI recurrence (pooled HR = 0.787, 95% CI: 0.693-0.894) and revascularization procedures (pooled HR = 0.858, 95% CI: 0.755-0.975). Moderate-certainty evidence (GRADE assessment) supports antidepressant efficacy in improving depressive symptoms, while low-certainty evidence suggests potential cardiac risk reduction.

Conclusion: This meta-analysis demonstrates that antidepressants are effective and well-tolerated in the treatment of post-MI depression. Antidepressants can improve depressive symptoms without adversely affecting long-term prognosis. The clinical application of these findings should consider the moderate certainty for symptom improvement and low certainty for MI recurrence benefits.