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Treatment of depression in patients with heart disease
1Department of Psychiatry, College of Physicians & Surgeons, Columbia University, and the Late Life Depression Research Center, New York State Psychiatric Institute, New York 10032, USA.
Insights
Patients with depression face higher risks of heart disease and death. Selective serotonin reuptake inhibitors (SSRIs) appear safer for the heart than tricyclic antidepressants (TCAs) in these patients.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Depression is linked to increased risk of ischemic heart disease and cardiac mortality.
- This association may stem from increased platelet activity and autonomic imbalance, raising susceptibility to ventricular fibrillation.
- Tricyclic antidepressants (TCAs) might elevate mortality risk in patients with existing ischemic heart disease.
Purpose of the Study:
- To evaluate the cardiovascular safety of antidepressants in patients with ischemic heart disease.
- To compare the cardiac profiles of selective serotonin reuptake inhibitors (SSRIs) and TCAs.
- To inform treatment choices for depression in cardiac patients.
Main Methods:
- Review of available data on antidepressant use in patients with ischemic heart disease.
- Analysis of three studies investigating SSRIs, including a randomized comparison of paroxetine and nortriptyline.
- Assessment of cardiovascular outcomes associated with different antidepressant classes.
Main Results:
- Selective serotonin reuptake inhibitors (SSRIs) demonstrate a relatively benign cardiovascular profile.
- Tricyclic antidepressants (TCAs) may be associated with an increased risk of mortality in patients with ischemic heart disease.
- Evidence suggests SSRIs are preferable to TCAs for depressed patients at risk for cardiac events.
Conclusions:
- SSRIs are likely a safer choice than TCAs for treating depression in patients with ischemic heart disease.
- Further research is necessary to definitively confirm the cardiovascular safety of SSRIs.
- Antidepressant selection should consider cardiac risk in patients with ischemic heart disease.
Abstract:
Patients with depression are more likely than patients without depression to develop ischemic heart disease and suffer cardiac-related death. Recent evidence suggests that the association between depression and increased cardiac mortality may in part be due to an increase in platelet activity and an imbalance in sympathetic and parasympathetic activity that makes the patient more susceptible to ventricular fibrillation. Available data suggest that the tricyclic antidepressants (TCAs) may increase the risk of mortality in patients with ischemic heart disease. Three studies with the selective serotonin reuptake inhibitors (SSRIs), including a double-blind, randomized comparison of paroxetine with nortriptyline, support the conclusion that the SSRIs have a relatively benign cardiovascular profile. Therefore, they are preferable to the TCAs for treatment of depression in patients at risk for cardiac events. Additional studies are needed to definitively establish the cardiovascular safety of the SSRIs.