Cardiovascular toxicity of antidepressant medications

This article reviews the cardiovascular effects of the standard tricyclic antidepressant agents and the cardiovascular effects of the newer antidepressant drugs. The cardiovascular effects of the standard tricyclic agents are orthostatic hypotension, conduction delay, and a potent antiarrhythmic effect. Patients with congestive heart failure receiving cardiac medications are at greatly increased risk for orthostatic hypotension, while patients with preexisting conduction delay are at risk for heart block. Of the newer antidepressant drugs, mianserin, nomifensine, and bupropion initially appeared to be most promising in terms of cardiovascular effects, but subsequently proved to have other serious liabilities; these agents require further testing. Trazodone has emerged as the antidepressant drug with the least risk of death in overdose, and as a useful alternative to the standard tricyclic antidepressant drugs in patients with preexisting conduction disease. However, trazodone therapy has been associated with some adverse effects, and, therefore, from the data presented in this paper, it can be concluded that no drug currently available is without some cardiovascular risk.