Acute emotional stress has been recognized as a trigger of cardiovascular events in a phenomenon known as mental stress-induced myocardial ischaemia (MSIMI). Results of the single-centre REMIT study now show that treatment with a selective serotonin reuptake inhibitor can reduce the occurrence of MSIMI in patients with stable coronary heart disease and pre-existing MSIMI.

Participants were randomly allocated to receive escitalopram (n = 64; 5 mg per day starting dose, increasing to 20 mg per day at 3 weeks and thereafter) or placebo (n = 63) for 6 weeks. Patients also continued to take their standard cardiac medication. At the end of the trial period, all individuals underwent the same three mental stress tasks—mental arithmetic, mirror trace, and public speaking with anger recall—and then treadmill exercise testing.

A total of 56 individuals in each group completed the end-point assessments. Patients who received the antidepressant were more likely than those taking placebo to be free from MSIMI during the three mental stress tasks (34.2% vs 17.5%; OR 2.62, 95% CI 1.06–6.44, P = 0.04). However, no significant difference existed between the groups in the occurrence of exercise-induced ischaemia.

Individuals taking escitalopram showed a reduction in the number of platelet serotonin receptor transporters and altered platelet serotonin uptake, compared with those taking placebo, which the researchers speculate might reduce platelet aggregation. Alternatively, the investigators suggest that “enhancing central synaptic availability of serotonin may be an important step in the management of coronary heart disease”.