Wan Hongquan, Li He, Luan Shuxin, Zhang Chunguo
Department of Mental Health, The First Hospital of Jilin University, No.1 Xinmin Road, Changchun, 130021, China.
Department of Pain Medicine, The First Hospital of Jilin University, No.1 Xinmin Road, Changchun, 130021, China.
BMC Psychiatry. 2025 Apr 23;25(1):416. doi: 10.1186/s12888-025-06843-y.
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.
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.
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.
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.
本研究旨在总结现有数据，并评估抗抑郁药在治疗心肌梗死后（MI）相关抑郁症方面是否有效且耐受性良好。
对公共数据库（PubMed、Embase、Web of Science、Ovid、EBSCO和Cochrane图书馆）进行全面检索，以查找2024年10月之前关于MI后抑郁症干预措施的出版物。关键词包括心肌梗死后抑郁症、抗抑郁药、心肌梗死和抑郁症。使用Stata软件对汇总数据进行分析。
共纳入12项研究。在基线时，抗抑郁药治疗组和对照组之间的抑郁严重程度无显著差异（合并标准化均数差= -0.022，95%可信区间：-0.087至0.044）。长期随访后，抗抑郁药治疗显著降低了抑郁评分（合并标准化均数差= -1.023，95%可信区间：-1.671至-0.375）。与对照组相比，治疗组不良心脏事件的发生率没有显著更高（合并风险比=0.893，95%可信区间：0.793至1.005）。抗抑郁药不会增加全因死亡率风险（合并风险比=0.957，95%可信区间：0.699至1.311），心脏病再住院风险也无显著差异（合并风险比=1.070，95%可信区间：0.820至1.398）。抗抑郁药治疗与MI复发风险降低（合并风险比=0.787，95%可信区间：0.693至0.894）和血运重建手术风险降低（合并风险比=0.858，95%可信区间：0.755至0.975）相关。中等确定性证据（GRADE评估）支持抗抑郁药在改善抑郁症状方面的疗效，而低确定性证据表明可能降低心脏风险。
这项荟萃分析表明，抗抑郁药在治疗MI后抑郁症方面有效且耐受性良好。抗抑郁药可以改善抑郁症状，而不会对长期预后产生不利影响。这些研究结果的临床应用应考虑症状改善的中等确定性和MI复发获益的低确定性。
