It?s not surprising that a life-changing event like a heart attack often leads to depression. In one study, nearly 20 percent of patients had severe depression after a heart attack. We?ve known for more than a decade that major depressive episodes, and even less severe depression, decrease survival after a heart attack and can be associated with a fourfold increase in the risk of another attack. What we didn?t know was whether treating depression would be helpful.

A study published this July examined the effect of treating depression in 1834 patients who were depressed after a heart attack. Patients treated with one type of antidepressant medication, serotonin reuptake inhibitors (SSRIs), had nearly 50 percent lower rates of mortality and recurrence of heart attacks during an average follow-up period of 29 months. Other types of antidepressants also appeared to help but the results weren?t statistically significant. No improvement in outcomes was seen with psychiatric treatments that did not employ medications. The failure of depressed patients to follow healthy behaviors and to take prescribed medications may account for their greater risk for repeat heart attacks.

The findings of this study need to be confirmed with a larger randomized trial. Nonetheless, I strongly favor aggressive treatment of depression after a heart attack, not only to keep patients alive longer but also to improve their quality of life.