A study of cardiovascular disease, depression and antidepressants on a computerised general practice database

Previous evidence suggests there is an association between cardiovascular d isease and depression. Tricyclic antidepressants (TCAs) are contraindicated in patients with a recent history of cardiovascular disease. 5678 patients between the ages of 50 and 79 years and with a new acute cardiac event wer e selected from a computerised general practice database and followed up fo r one year. 'New episodes' of diagnosed depression were identified and trea tment with antidepressants was investigated. 183 656 patients aged 50-79 ye ars without a cardiac event were used for comparison. A significant associa tion was found between cardiovascular disease and a new diagnosis of depres sion (adjusted OR = 2.23, 95 per cent CI 1.90-2.62). Patients who had suffe red a recent cardiac event were less likely to be prescribed a TCA than an SSRI (adjusted OR = 0.59, 95 per cent CI 0.41-0.85). However, 35 per cent o f patients with a recent cardiac event were initially prescribed a TCA. The findings indicate that general practitioners recognise the dangers of pres cribing TCAs to patients with a recent history of cardiovascular disease. H owever, a substantial minority of cardiac patients were prescribed TCAs whe re they may not have been the optimal choice. (C) 1999 John Wiley & Sons, L td.