In Reply Drs Ströhle and Rieckmann express skepticism about the Effects of Selective Serotonin Re-Uptake Inhibition on Morbidity, Mortality, and Mood in Depressed Heart Failure Patients (MOOD-HF) study hypothesis that escitalopram would reduce mortality and morbidity in depressed patients with heart failure. Depression is an established risk marker for incident cardiac disease and associated with adverse outcomes in cardiovascular patients.1 In heart failure, it predicts death and rehospitalization with incidence rates rising in parallel with symptom severity.2 Increasing depressive symptoms may worsen3 and depression remission improve4 cardiovascular outcomes. These observations provide an excellent rationale for investigating whether altering depression with an antidepressant would modify risk and improve prognosis in heart failure.
Angermann CE, Deckert J, Ertl G. Escitalopram and Outcomes Among Patients With Depression and Heart Failure—Reply. JAMA. 2016;316(14):1494-1495. doi:10.1001/jama.2016.13888