The effect of antidepressants on lipid homeostasis: a cardiac safety concern?
OBJECTIVE
The authors sought to summarise and synthesise results from investigations which report on the effect of antidepressants on serum lipid homeostasis.


METHODS
The authors conducted a MedLine search of all English-language articles from 1966 to March 2006 using the search terms: major depressive disorder, bipolar disorder, lipids, triglycerides, cholesterol, low-density lipoprotein, high-density lipoprotein, and the non-proprietary names of conventional antidepressants indicated for the treatment of major depressive disorder in North America as of March 2006. The search was supplemented with a manual review of retrieved articles for any further citations reporting the effects of antidepressants on lipid homeostasis.


RESULTS
Despite the paucity of well-characterised investigations, the unfavourable effect of weight gain promoting antidepressants (e.g., tricyclics, mirtazapine) on serum lipid parameters (i.e., triglycerides and low-density lipoprotein cholesterol) is a consistent finding. Weight-neutral antidepressants (e.g., bupropion, venlafaxine, duloxetine), however, are less likely to disrupt the lipid milieu. A weight-independent effect on lipid homeostasis is less consistently reported.


CONCLUSIONS
Some antidepressants unfavourably influence the lipid milieu; mediating factors other than weight gain are not well-established. Pivotal studies evaluating the therapeutic index of antidepressants need to systematically collect and report data on the lipid effects of antidepressants.
McIntyre
Roger S
RS
University of Toronto, Department of Psychiatry, Toronto, ON, Canada. roger.mcintyre@uhn.on.ca
Soczynska
Joanna K
JK
Konarski
Jakub Z
JZ
Kennedy
Sidney H
SH
D000328:Adult; D000368:Aged; D000818:Animals; D000928:Antidepressive Agents / Q000009:adverse effects*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D008078:Cholesterol, LDL / Q000097:blood; D015243:Cholesterol, VLDL / Q000097:blood; D003865:Major Depressive Disorder / Q000097:blood / Q000188:drug therapy*; D050171:Dyslipidemias / Q000097:blood / Q000209:etiology*; D005260:Female; D006706:Homeostasis; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D015430:Weight Gain / Q000187:drug effects
D000928:Antidepressive Agents; D008078:Cholesterol, LDL; D015243:Cholesterol, VLDL; D014280:Triglycerides