The Effects Of Sertraline On Depression And Incidence Of Cardiovascular Events Of Patients With Coronary Heart Diseases Combined With Depression

Background: The researches for cause of morbidity on Coronary Heart Disease (CHD), a serious threat to human health, have achieved compelling achievements by investigating various risky factors which might lead to CHD. Besides traditional risky factors, more and more studies show that psychological factor has important influence on onset and progonosis of CHD—the combination of psychological factor and other traditional risky factors make acute heart attack incidental for CHD patients. Domestic and international researches show that CHD patients are usually in depressive state, which greatly hinder their recovery.Objectives: To observe the effects of sertraline on depression and incidence of cardiovas -cular events of patients with coronary heart diseases combined with depression and exploration for possible mechinisms involved stertraline effects.Method: CHD inpatients were chosen as objects been operated with manipulation of Coronary Stent Placement (CSP) in Cardiovascular Clinic of The Second Subsidiary Hospital of Yangzhou University during June 2006 and October 2007. They were investigated by Hospital Anxiety and Depression Scale (HAD) and Hamilton Depression Rating Scale for Depression (HAMD) two days before they left the hospital. Special CHD patients with depression were screened out and randomly divided into intervention group and control group. All patients received regular treatment after manipulation of CSP. On the basis of regular treatment, patients of intervention group took 50 mg Sertraline every morning after breakfast with treatment period of 12 weeks. The effect of anti-depressive treatment of Sertraline on depression of CHD patients and on incident rate of cardiovascular events was observed. Other biochemical and pathophysiocal indices change of patients before and after treatment, including High Sensitive C receptor Protein (HS-CPR), Interleukin-6 (IL-6), Tumor Necrosis Factor-α(TNF-α), Endothelin-1 (ET-1), Nitrogen Monoxidum (NO), Soluble P-selectin (SP-selectin), and Heart Rate Variability (HRV) were determined.Results: 1. During research period, total 330 HAD have been issued. 76 patients were in accordance with depression diagnosis. The incident rate is 23%. Follow-up for 67 patients was accomplished. 2. Depression: Depression of patients after Sertraline treatment is significantly relieved. The relieved rate and effective rate is 37.5% and 81.2% respectively. The HAMD scores is reduced by 11.56±3.91. The enhancement of effective rate and the reduction of HAMD scores were more significant than patients without Sertraline treatment. Both differences reached to statistical significance (both P<0.01). 3. Cardiovascular events: Sertraline treatment significantly decreased incident rate of adverse cardiovascular events for CHD patients with depression, compared to the control group, 12.5% vs 34.3%, P<0.05. 4. Platelet activity: SP-selectin content of patients after Sertraline treatment was decreased obviously, compared to that before Sertraline treatment, P<0.05, while decrease of P-selectin of control group was not significant. P-selectin content of patients with intervention group after Sertraline treatment was decreased more obviously than that of control group after treatment (217.38±189.57ng/mL vs 311.23±188.15ng/mL, P<0.05). 5. Inflammatory reaction: (1) hs-CRP: No matter Sertraline treatment was adopted or not, hs-CRP of patients in both groups after treatment was decreased obviously, compared to that before treatment, P<0.01, while the decrease of hs-CRP of intervention group with Sertraline treatment was more significant. However, the difference between intervention and control groups did not reach statistical significance (8.36±6.30 mg/L vs 10.38±8.11 mg/L,P>0.05). (2) IL-6 and TNF-α: the plasma content of IL-6 and TNF-αof patients in both groups had decreasing trends. The decline of intervention group with Sertraline treatment was more obvious, but the differences between both groups did not reach statistical significance. (Both of IL-6 and TNF-α, P>0.05). 6. Endothelial function: (1) NO: NO of patients after Sertraline treatment was augmented obviously, compared to that before Sertraline treatment, P<0.05, while increase of NO of control group was not significant. NO of patients after Sertraline treatment was increased more obviously than that of control group after treatment. However, the difference did not reach statistical significance (P=0.836). (2) ET-1: ET-1 of patients after Sertraline treatment was decreased significantly compared to that before Sertraline treatment, P<0.01. ET-1 of control group was decrease too, but the difference did not reach statistical significance. 7. Heart Rate Variability (HRV): (1) SDNN, Sertraline treatment obviously improved SDNN while change of SDNN of control group was not obvious. SDNN of patients after Sertraline treatment increased more obviously than that of control group. (2) HF: Both HF of two groups increased after respectively treatement. The increase of HF of intervention group was more obvious. However, the differences did not reach statistical significance. (3) LF: the LF of two groups decreased after respectively treatment obviously (P<0.01). The decrease of LF of intervention group was more obvious. However, the difference did not reach statistical significance (P>0.05). 8. Adverse drug reactions: During period of Sertraline treatment, there were 5 cases with nausea and anorexia, 2 cases with diarrhea (one patient of two quitted from experiment), 1 case with dizziness, 1 with xerostomia, and 1 with delayed sexual orgasm. All these nonrecurring adverse reactions occurred in the 1st and the 2nd weeks after patients'taking medicine. There were no obvious abnormalities for remaining patients.Conclusions: 1. Depression is one of common emotional disorders in patients after manipulation of PCI with about 23% incident rate. 2. Sertraline treatment can not only relieve depression of CHD patients with depression, but also decrease incident rate of adverse cardiovascular events and improve short-term progonosis of patients. 3. Sertraline treatment can decrease SP-selectin and increase SDNN of patients, possiblly involved Sertraline treatment induced decreased platelet activity of CHD patients with depression and improved autonomic nervous function. 4. Sertraline doesn't show extra effects to relieve inflammatory reaction and to improve endothelial function. 5. The adjustment effect of Sertraline to platelet activity and autonomic nervous function might contribute to its benefit of decreasing incident rate of adverse cardiovascular events. 6. Sertraline treatment is safe and effective for CHD patients with depression.