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Antidepressants and cardiovascular adverse events: A narrative review
Mohammad Hassan Nezafati1, Mohammad Vojdanparast2, Pouya Nezafati3
1Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Depression is common in heart disease patients. A new categorization of antidepressants helps select safer options, minimizing cardiovascular risks and improving mood.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Major depression frequently complicates cardiovascular diseases like coronary heart disease and heart failure.
- Antidepressant treatment can improve mood in cardiac patients but carries risks of adverse cardiac events.
- Understanding these risks is crucial for effective patient management.
Purpose of the Study:
- To review existing literature on the beneficial and harmful effects of various antidepressants in patients with heart disease.
- To propose a novel categorization of antidepressants based on their cardiovascular safety profiles.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Web of Science, SCOPUS, etc.).
- Forty eligible studies, including randomized clinical trials, cohort studies, and meta-analyses, were assessed.
- The review focused on studies evaluating antidepressant effects on cardiovascular outcomes.
Main Results:
- Antidepressants were categorized into three groups based on cardiovascular risk: safest (e.g., selective serotonin reuptake inhibitors), neutral (e.g., serotonin-norepinephrine reuptake inhibitors), and harmful (e.g., tricyclic antidepressants).
- Safest drugs demonstrated cardio-protective effects on ventricular function and cardiac conduction.
- Harmful drugs exhibited adverse effects on cardiac function, hemodynamics, and heart rate variability.
Conclusions:
- The proposed categorization provides a clinical framework for selecting antidepressants with minimized cardiovascular risks.
- This approach aims to optimize mood management in cardiac patients while prioritizing cardiac safety.
Background:
Major depression or deterioration of previous mood disorders is a common adverse consequence of coronary heart disease, heart failure, and cardiac revascularization procedures. Therefore, treatment of depression is expected to result in improvement of mood condition in these patients. Despite demonstrated effects of anti-depressive treatment in heart disease patients, the use of some antidepressants have shown to be associated with some adverse cardiac and non-cardiac events. In this narrative review, the authors aimed to first assess the findings of published studies on beneficial and also harmful effects of different types of antidepressants used in patients with heart diseases. Finally, a new categorization for selecting antidepressants according to their cardiovascular effects was described.
Methods:
Using PubMed, Web of Science, SCOPUS, Index Copernicus, CINAHL, and Cochrane Database, we identified studies designed to evaluate the effects of depression and also using antidepressants on cardiovascular outcome. A 40 studies were finally assessed systematically. Among those eligible studies, 14 were cohort or historical cohort studies, 15 were randomized clinical trial, 4 were retrospective were case-control studies, 3 were meta-analyses and 2 animal studies, and 2 case studies.
Results:
According to the current review, we recommend to divide antidepressants into three categories based on the severity of cardiovascular adverse consequences including (1) the safest drugs including those drugs with cardio-protective effects on ventricular function, as well as cardiac conductive system including selective serotonin reuptake inhibitors, (2) neutralized drugs with no evidenced effects on cardiovascular system including serotonin-norepinephrine reuptake inhibitors, and (3) harmful drugs with adverse effects on cardiac function, hemodynamic stability, and heart rate variability including tricyclic antidepressants, serotonin antagonist and reuptake inhibitors, and noradrenergic and specific serotonergic antidepressants.
Conclusion:
The presented categorization of antidepressants can be clinically helpful to have the best selection for antidepressants to minimizing their cardiovascular harmful effects.
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