Treatment of Depression in Patients With Heart Disease

Patients with depression are more likely than patients without depression to develop ischemic heart disease and suffer cardiac-related death. Recent evidence suggests that the association between depression and increased cardiac mortality may in part be due to an increase in platelet activity and an imbalance in sympathetic and parasympathetic activity that makes the patient more susceptible to ventricular fibrillation. Available data suggest that the tricyclic antidepressants (TCAs) may increase the risk of mortality in patients with ischemic heart disease. Three studies with the selective serotonin reuptake inhibitors (SSRIs), including a double-blind, randomized comparison of paroxetine with nortriptyline, support the conclusion that the SSRIs have a relatively benign cardiovascular profile. Therefore, they are preferable to the TCAs for treatment of depression in patients at risk for cardiac events. Additional studies are needed to definitively establish the cardiovascular safety of the SSRIs.