MOOD-HF supports lack of antidepressant efficacy in HF patients

By Eleanor McDermid

Escitalopram influences neither depressive symptoms nor medical outcomes when compared with placebo in patients with heart failure (HF) and depression, show the MOOD-HF findings.

"These observations support the concept of alternative pathophysiological mechanisms for mood disorders in somatic illnesses", the researchers write in JAMA.

They note that the findings of MOOD-HF (Effects of Selective Serotonin Re-Uptake Inhibition on Morbidity, Mortality, and Mood in Depressed Heart Failure Patients) are in line with those of the SADHART-CHF trial.

They add that MOOD-HF used escitalopram, which is "considered superior to" sertraline, which was used in SADHART-CHF. Moreover, MOOD-HF extended the treatment time from 12 weeks to 24 months, resulting in a longer duration of treatment with a theoretically more effective drug.

The 372 patients in MOOD-HF had a left ventricular ejection fraction of 45% or less and depression as determined on the 9-item Patient Health Questionnaire. Around two-thirds had previously been hospitalised for HF.

During 24 months of treatment, 63% of patients randomly assigned to escitalopram (10-20 mg/day; average 15.8 mg) were either hospitalised or died of any cause, as were 64% of placebo-treated patients. There was no significant difference between the groups.

Most endpoints were due to hospitalisation, with only 10% of the escitalopram group and 7% of the placebo group dying during follow-up.

Patients taking escitalopram had marked improvements in depressive symptoms, with average scores on the Montgomery-Åsberg Depression Rating Scale falling from 20.2 at baseline to 11.2 at 12 weeks. However, the same occurred in the placebo group, with scores falling from 21.4 to 12.5, so there was again no difference between the groups.

Depression is associated with poor outcomes in cardiovascular patients, say Christiane Angermann (University and University Hospital Würzburg, Germany) and study co-authors. However, in an exploratory analysis, the likelihood of primary outcome events was not influenced by the change in patients' depressive symptoms, whether in response to escitalopram or placebo.

"Placebo-controlled trials of antidepressants tended to exclude patients with severe somatic illnesses", they observe.

The team therefore concludes that the efficacy findings of antidepressant trials "may not necessarily be transferable to all individuals in whom antidepressants are prescribed in clinical practice."

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