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We thank Drs. Carney and Freedland for their perspective. We performed the analyses that they suggested by estimating separate hazard ratios for four categories of women from the Nurses' Health Study, according to presence of severe depressive symptoms (MHI-5 score<53) and/or reported use of antidepressant medications. In multivariable, analyses, the hazard ratios associated with each category are listed below. The risk of sudden cardiac death was significantly elevated among women treated with antidepressants regardless of whether they continue to exhibit severe depressive symptoms. Although the hazard ratio was slightly higher among those who exhibited severe depressive symptoms, confidence intervals overlapped. Also, we did not find evidence for an interaction between MHI-5 score category and antidepressant use in separate multivariable models that used a cross-product term. Therefore, we were unable to find strong evidence in support of Drs. Carney and Freedland's hypothesis in our data; however, we strongly agree that further research into prognosis of depression and treatment-resistant depression, and the underlying mechanisms, is needed.
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William Whang, Columbia University Medical Center, Cardiology, Harkness 366, 180 Ft. Washington Ave., New York, NY, 10032, Phone: 212 305 8620, Fax: 212 305 3137.
Christine Albert, Brigham and Women's Hospital.