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Escitalopram ineffective for depression, mortality, hospitalization in patients with heart failure, depression

Eighteen months of escitalopram treatment did not significantly improve mortality, hospitalization or depression symptoms in individuals with chronic heart failure with reduced ejection fraction and depression.

“Compared with the general population, depression is two to three times more common in patients with cardiovascular disease,” Christiane E. Angermann, MD, of the University Hospital Würzburg, Germany, and colleagues wrote. “In patients with coronary disease, randomized studies showed that [selective serotonin reuptake inhibitors (SSRIs)] were safe and might improve depression, but had no beneficial effect on prognosis. However, post hoc analyses from the Enhancing Recovery in Coronary Heart Disease trial indicated that prolonged SSRI treatment might reduce mortality and morbidity.”

To determine if 24 months of escitalopram improved mortality, morbidity and mood in individuals with chronic systolic heart failure and depression, researchers conducted a double-blind, placebo-controlled randomized clinical trial at 16 tertiary medical centers in Germany. Individuals from outpatient clinics with New York Heart Association class II-IV heart failure and reduced left ventricular ejection fraction and depression received 10 mg to 20 mg of escitalopram or placebo in addition to optimal heart failure therapy. Study participants had a mean age of 62 years.

Overall, 372 participants were randomized and had taken at least one dose of study medication when the data and safety committee recommended the trial be stopped early. Median participation time was 18.4 months for the escitalopram group (n = 185) and 18.7 months in the placebo group (n = 187).

Death or hospitalization occurred in 63% of patients receiving escitalopram and 64% of participants receiving placebo.

From baseline to 12 weeks, mean Montgomery-Åsberg Depression Rating Scale sum scores decreased from 20.2 to 11.2 in the escitalopram group and 21.4 to 12.5 in the placebo group, with a between-group difference of –0.9 (95% CI, –2.6 to 0.7); P = .26).

Safety parameters were comparable among groups, according to researchers.

“In patients with chronic heart failure with reduced ejection fraction and depression, 18 months of treatment with escitalopram compared with placebo did not significantly reduce all-cause mortality or hospitalization, and there was no significant improvement in depression. These findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression,” the researchers concluded. – by Amanda Oldt

Disclosure: Angermann reported receiving grants, personal fees, nonfinancial support, and other from ResMed; grants, personal fees, and other from Novartis; personal fees and other from Servier; grants and personal fees from Thermo Fisher, Boehringer Ingelheim, and Vifor; personal fees, grants, and nonfinancial support from Lundbeck AS; nonfinancial support from the University Hospital Würzburg and the Comprehensive Heart Failure Center Würzburg; and grants from the German Ministry for Education and Research. Please see the full study for a list of all authors’ relevant financial disclosures.