[Relationships between mental and cardiac diseases]

Affective and schizophrenic illnesses are associated with an elevated--in particular cardiovascular-related--risk of mortality. Patients with a cardiac disease who suffer from episodes of depression should be treated with selective serotonin reuptake inhibitors. Sertraline and citalopram have a low potential for interaction. Thioridazine, pimozid and ziprasidone are the substances that most commonly lead to lengthening of the QTc interval and thus to repolarization disorders. However, the results of studies carried out to date show that, in contrast to thioridazine and pimozid, ziprasidone has not so far been suspected of having an association with sudden heart death. Prior to starting treatment with tricyclic antidepressants or neuroleptics, a baseline ECG should be obtained. Follow-up ECG should be recorded and consideration given to possible drug interactions leading to cardiac arrhythmias, in particular when low-potency antipsychotics are used.