Cardiology Letters 2020, 29(3):160-165

The effect of antidepressants on the cardiovascular system and the safety of cardiovascular drugs in depressive disorders

Beňová K¹, Horvátová Z²

¹ Interná konziliárnA ambulancia FNsP J. A. Reimana, Prešov

² Psychiatrické oddelenie FNsP J. A. Reimana, Prešov, Slovenská republika

Standard risk factors (RFs) for cardiovascular diseases (CVD) are well known, and other RFs include depression. Patients with depressive disorders have an increased risk of developing CVD; on the other hand, the presence of CVD in patients may represent an increased incidence of depressive disorders. The pathophysiological mechanisms of this relationship are complex. The prevalence of metabolic syndrome is higher in patients with depressive disorders than in the general population. Some biological markers are common in patients with MS and depression. These include dysfunction of the hypothalamic-pituitaryadrenal cortex axis, which leads to chronic increases in glucocorticoid levels, impaired insulin's ability to initiate glucose uptake, abdominal obesity, dyslipidemia, and insulin resistance. Patients with depression have elevated cortisol levels, associated with hypertension, fluid retention, and increased platelets in the blood, as well as increased platelet activation (and thus an increased risk of arterial thrombosis, which could explain the co-occurrence of depression and CVD). The correct choice of antidepressant with regard to CVD is important in patients with depressive disorders : to avoid antidepressants that have metabolic side effects (TCA, paroxetine, sertraline, venlafaxine, mirtazapine, MAOI), to prefer drugs that do not cause catecholaminergic hypertension and serotonine syndrome, to avoid antidepressants that potentiate the proarrhythmogenic effect of antiarrhythmics. In patients with CVD (due to depressive disorders), drugs where depressive effects are possible should be avoided. Tab. 2, Ref. 9, on-line full text (Free, PDF) www. cardiologyletters.sk

Keywords: depression; antidepressants; metabolic syndrome; cardiovascular diseases

Published: March 1, 2020  Show citation