Recent studies indicate that selective serotonin reuptake inhibitors (SSRIs) constitute a major advance in the management of depressed patients with heart disease. Randomized controlled trials are required to document their beneficial effects over a 5- to 7-year period. The antidepressant heart attack randomized trial (SADHART) studied 370 patients with acute MI or unstable angina and major depressive disorder. After a two-week placebo run, patients were randomized to receive sertraline (Zoloft), 50 mg daily or placebo for 24 weeks. Approxi¬mately 33% of these patients had previous episodes of depression. Results indicated that sertraline was effective in treating patients with more severe, recurrent episodes of depression. This drug did not cause adverse cardiac effects, for example, changes in left ventricular ejection fraction or other cardiac measurements. The incidence of the cardio¬vascular events was less frequent in this group, and 22.4% versus 14.5% in the placebo group. This difference did not reach statistical significance, but it is reassuring that no adverse cardiac effects were observed and depression was significantly ameliorated. This was a short-term study and trials to observe whether these agents reduce cardiac mortality long-term are necessary.

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