Smokers who take certain antidepressants such as Prozac and Zoloft run a dramatically lower risk of a first heart attack, a U.S. study suggests.

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October 16, 2001

By James Winshall, M.D.
Harvard Medical School

How does this article relate to me?

Researchers at University of Pennsylvania found an interesting and unexpected link between antidepressants and a lower risk of heart disease in smokers. To date, there have been few others studies or experimental evidence that would have predicted these findings.

These results are intriguing. Could antidepressants have a direct effect on the chain of events that trigger a heart attack? While we think of antidepressants working in the brain, we know that medications often affect more than one part of the body. It's possible that antidepressants could act as blood thinners, or change cholesterol levels. We also know that depressed people appear to have an increased risk of heart attacks. Perhaps solely by treating the depression, the medication reduced the rate of heart disease. Since this study only looked at smokers, we don't know if the same results would be found in depressed people who don't smoke.

It is also important to keep in mind that these are preliminary results. In fact, the researchers did not expect to find this connection when they designed their study. Under these circumstances, we should be suspicious about this link between antidepressants and the risk of heart disease. In other words, flaws in the design of the study or misinterpretation of the results may produce misleading conclusions about the cause-and-effect relationship between the medication and heart attacks.

What changes do I need to make?

There is no question that smoking dramatically increases your risk of heart disease. If you smoke, quit now. If you don't smoke, don't start. There is also clearly a connection between depression and heart disease. In particular, those who have already suffered a heart attack seem at very high risk of becoming depressed. The depression in turn increases the likelihood that these people won't take their medications, see their doctor, exercise and eat right, etc. If you are depressed, and are at risk for heart disease or have already had a heart attack, be sure to see your doctor to discuss treatment options.

However, it seems premature to recommend that smokers take specific antidepressants in order to lower their risk of heart disease. Instead, smokers should focus on treatment aimed at helping them to quit smoking.

What can I expect in the future?

Preliminary findings always need to be confirmed. Look for additional studies about the antidepressants and heart disease. If this effect is real, there will undoubtedly be additional research on how these medications actually work.

Related areas:

Smoking Cessation