Use of Serotonin and Catecholamine Reuptake Inhibitors and Onset of Takotsubo Syndrome

Takotsubo Syndrome (TS) is an acute, transient heart failure primarily affecting older women. Excessive sympathetic stimulation from emotional or physical stressors is assumed to trigger TS through a toxic surge in plasma catecholamines. Case reports have signaled the onset of TS following treatment with serotonin and catecholamine reuptake inhibitors. This case-control study investigated whether the use of these medications could be associated with TS onset.

Incident TS cases (n=98) and myocardial infarction (MI; n=32) controls were recruited among women admitted to five emergency departments in New England. Information on psychotropic medications was abstracted from medical records. Logistic regression models were used to examine associations between preadmission psychotropic medication use and TS onset.

Demographics were similar between groups (98 TS, 32 MI) except for race (92% White in TS vs. 78% in MI). TS women more frequently had a history of any psychiatric disorder (50% vs. 28%, p =.002); mood disorders, 32% vs. 22% ( p =.41); anxiety disorders, 32% vs. 9% ( p =.024). Logistic regression models adjusting for psychiatric comorbidity showed that women with TS were more likely to have taken any psychotropic medication (OR=4.10; CI=1.42, 5.0) or any catecholamine or serotonin reuptake inhibitor preadmission (OR=3.39; CI=1.17, 12.3). Analysis by medication type showed the latter association was driven by associations with SNRI use (11% vs. 0%; p =.10).

These findings suggest that the use of catecholamine or serotonin reuptake inhibitors may increase the risk of TS. The use of such medications should be carefully considered in TS survivors.