Antidepressant drugs and cardiovascular pathology: a clinical overview of effectiveness and safety.
OBJECTIVE
To review data examining the relationships between depression, antidepressants and cardiovascular disease.


METHODS
Structured searches of PubMed, Medline and Embase conducted in March 2008.


RESULTS
Depression and cardiovascular disease are closely associated clinical entities. Depression appears both to cause and worsen cardiovascular disease. Cardiovascular disease is in turn associated with a high incidence of depression. Depression is associated with increased mortality in cardiovascular disease, and after myocardial infarction (MI) and stroke. Many antidepressants have cardiotoxic properties. Tricyclic drugs are highly cardiotoxic in overdose and may induce cardiovascular disease and worsen outcome in established cardiovascular disease. Reboxetine, duloxetine and venlafaxine are known to increase blood pressure. Other antidepressants have neutral or beneficial effects in various cardiovascular disorders.


CONCLUSIONS
Sertraline, fluoxetine, citalopram, bupropion and mirtazapine appear to be safe to use after MI; the use of sertraline, and response to citalopram and mirtazapine may improve mortality. Paroxetine and citalopram appear to be safe to use in patients with established coronary artery disease. Limited data suggest that a variety of antidepressants are effective and safe to use after stroke.
Taylor
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Pharmacy Department, Maudsley Hospital and Division of Pharmaceutical Sciences, King's College, London, UK. david.taylor@slam.nhs.uk
D000928:Antidepressive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000523:psychology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012803:Sick Role; D015996:Survival Rate
D000928:Antidepressive Agents