Depression is a risk factor for coronary heart disease (CHD) and for other cardiovascular diseases. It cause high mortality in known patients. SSRIs are safe and have a negligible effect on the cardiovascular system, even in cases of overdose.

To examine the antidepressant effect of sertraline and paroxetine in patients with CHD after the incidence of an acute coronary event.

46 patients (26 female, mean age 59,8; 20 male, mean age 57,8) diagnosed with CHD, after 1-3 months from an acute coronary syndrome, no depression in the past, met the criteria for major depressive disorder (MDD) according to ICD10. It was performed HAMD 17 items.

Patients received either sertraline 75-150 mg/day (n=23; mean dose 104,3 mg/day) or paroxetine 20-30 mg/day (n=23; mean dose 22,6 mg/day). They were examined on baseline and days 7, 28, 56, 112, 168 using cardiologic evaluation, and depression rating scale HAMD. All treated patients had a significant improvement on HAMD score (from mean 21,8 to 10,6). Significant improvement was noted at 28 days of treatment. 12/46 (26,08%) were mildly improved and 34/46 (73,92%) were much or very much improved. No important side effects were recorded.

1) Patients with no recent history of depression suffering a cardiovascular event were more likely to be diagnosed with depression. 2) Diagnosis and treatment of depression should be incorporated into the clinical management of CHD 3) Sertraline and paroxetine are a safe and effective treatment in patients with CHD without other life-threatening medical conditions.