Response to Letter by Ma et al Regarding Article,“ Depression Treatment and 1-Year Mortality Following Acute Myocardial Infarction: Insights from the TRIUMPH Registry”

We would like to thank Ma and colleagues for their compliments on our work¹ and welcome the opportunity to respond to the comments that they raise in their letter. There are three distinct points that we want to address: First, as our study was an observational cohort study, it should never be used to derive conclusions from in terms of causation or effects depression treatment may have had on outcomes. This brings us to our second point: what we observed was that the association between depression and increased mortality risk following acute myocardial infarction (AMI) was restricted to those whose depressive symptoms were not recognized and treated. Therefore, we do not concur with the conclusion that Ma et al. derived: “anti-depressant therapy failed to improve the adjusted 1-year risk of mortality”. On the contrary, we saw that being on follow-up anti-depressant therapies explained 30% of the excess hazard for the association between depression recognition and 1-year mortality. Finally, we are able to provide more detail on the antidepressants the patients with depressive symptoms were on, for descriptive purposes only. At discharge, 51.9% of the patients with treated depression were on Selective Serotonin Reuptake Inhibitors; 6.9% were on Serotonin Norepinephrine Reuptake Inhibitors; 5.2% were on Serotonin Antagonist and Reuptake Inhibitors; 3.9% were on Norepinephrine Dopamine Reuptake Inhibitors; 2.6% were on Tetracyclic antidepressants; and no patients were on Monoamine Oxidase Inhibitors. As our study does not lend itself to derive conclusions in terms of efficacy of antidepressant treatments for AMI mortality outcomes, we therefore conclude by recommending that future, carefully designed randomized clinical trial work is still very much needed to derive definitive conclusions as to how depression treatments may or may not mitigate increased cardiovascular risk. It goes without saying that, even in the absence of more definitive trial evidence, it should be widely recognized that depression is a burdensome condition in itself that has widespread implications for the successful management of AMI.² Therefore, depression warrants treatment in its own right, regardless of its effects on cardiovascular prognosis.