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Published on: March 2, 2015

Antiplatelet effects of antidepressant treatment: a randomized comparison between escitalopram and nortriptyline

Anne Flöck1, Astrid Zobel, Gerhard Bauriedel

  • 1Department of Internal Medicine II - Cardiology, University of Bonn, Germany.

Thrombosis Research
|June 18, 2010
PubMed

Insights

Major depressive disorder is linked to increased platelet aggregation, a potential cardiovascular risk factor. Antidepressant treatment with escitalopram or nortriptyline significantly reduced platelet aggregation in responders after three months.

Area of Science:

  • Cardiology
  • Psychiatry
  • Pharmacology

Background:

  • Depressive disorders are recognized as independent risk factors for coronary heart disease.
  • Elevated platelet aggregation in depressed individuals may contribute to increased cardiovascular morbidity.

Purpose of the Study:

  • To compare platelet function in depressed patients versus healthy controls.
  • To analyze changes in platelet aggregation during 3 months of antidepressant treatment.
  • To assess differential effects of escitalopram and nortriptyline on platelet aggregation.

Main Methods:

  • Whole blood aggregometry was used to analyze blood samples from 91 major depressed patients and 91 healthy controls.
  • Depressed patients were randomized to receive either escitalopram (n=47) or nortriptyline (n=44).
  • Platelet aggregation was measured at multiple time points in response to adenosine diphosphate (ADP) and collagen.

Main Results:

  • Platelet aggregation induced by ADP was significantly higher in depressed patients compared to controls (26%, p=0.006).
  • Early changes in platelet aggregation were similar between escitalopram and nortriptyline groups.
  • After 84 days, responders showed significant reductions: escitalopram decreased ADP and collagen-induced aggregation by 23% (p=0.03) and 15% (p=0.03), respectively; nortriptyline reduced ADP-induced aggregation by 29% (p=0.046).

Conclusions:

  • Depressed patients exhibit heightened ex vivo platelet aggregation, potentially increasing cardiovascular risk.
  • Three months of antidepressant treatment with escitalopram or nortriptyline led to significant reductions in platelet aggregation among responders.
  • The observed reduction in platelet aggregation was independent of the specific antidepressant medication used.
Abstract

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