Cardiovascular Effects of Antidepressant Drugs: Updated

The cardiovascular effects of tricyclic antidepressants (TCAs), including the propensity of theseagents to be fatal in overdose, have been well described. It has been established further that even attherapeutic doses the TCAs may have untoward cardiovascular effects in the context of underlyingischemic heart disease. By comparison, the selective serotonin reuptake inhibitors (SSRIs) as a classare less likely to affect cardiovascular parameters in depressed patients who are otherwise healthy. Importantly,the SSRIs in overdose situations are enormously safer than TCAs and rarely have been associatedwith cardiotoxic effects when ingested alone. More recently, the safety and efficacy of several ofthe SSRIs have been evaluated in patients with existing ischemic heart disease. Although the studieshave involved a limited number of patients, the available data suggest that SSRIs are not associatedwith adverse cardiovascular effects in these patients and are safer than TCAs in the treatment of depressionin patients with heart disease. The prevalence of cardiovascular disease and the evidence that comorbiddepression with cardiovascular disease (for example, following myocardial infarction) increasesthe risk of mortality underscore the importance of understanding the cardiac effects ofantidepressants and the need for effective antidepressants that are free of adverse cardiovascular effects.At present, the SSRIs should be considered first-line agents for the treatment of depressed patientswith cardiovascular illness, particularly ischemic heart disease. Among the SSRIs, those with alower potential for causing pharmacokinetic drug interactions generally are preferred.