Cardiovascular Effects of Fluoxetine in Depressed Patients With Heart Disease

• Published in: The American journal of psychiatry Vol. 155; no. 5; pp. 660 - 665
• Main Authors: Roose, Steven P., Glassman, Alexander H., Attia, Evelyn, Woodring, Sally, Giardina, Elsa-Grace V., Bigger, J. Thomas
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01-05-1998; American Psychiatric Association
• Subjects: Adult; Aged; Antidepressive Agents, Tricyclic - adverse effects; Antidepressive Agents, Tricyclic - pharmacology; Antidepressive Agents, Tricyclic - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Cardiovascular disease; Cardiovascular response; Comorbidity; Depression; Depressive Disorder - drug therapy; Depressive Disorder - epidemiology; Drug Administration Schedule; Drug therapy; Drug toxicity and drugs side effects treatment; Electrocardiography - drug effects; Female; Fluoxetine; Fluoxetine - adverse effects; Fluoxetine - pharmacology; Fluoxetine - therapeutic use; Heart diseases; Heart Diseases - epidemiology; Heart Rate - drug effects; Hemodynamics - drug effects; Humans; Hypotension, Orthostatic - chemically induced; Male; Medical sciences; Mental depression; New York City; Nortriptyline - adverse effects; Nortriptyline - pharmacology; Nortriptyline - therapeutic use; Pharmacology; Pharmacology. Drug treatments; Serotonin Uptake Inhibitors - adverse effects; Serotonin Uptake Inhibitors - pharmacology; Serotonin Uptake Inhibitors - therapeutic use; Stroke Volume - drug effects; Toxicity: cardiovascular system; Treatment; Mood disorder; Human; Heart failure; Arrhythmia; Fluoxetine; Psychotropic; Toxicity; Cardiovascular disease; Depression; Heart rate; Chemotherapy; Treatment; Heart disease; Risk factor; Electrocardiography; Antidepressant agent; Blood pressure
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/ajp.155.5.660

OBJECTIVE: The purpose of this study was to determine the cardiovascular effects of fluoxetine in depressed patients with cardiac disease. METHOD: Twenty-seven depressed patients (26% of whom were female and whose average age was 73 years) who had congestive heart failure, conduction disease, and/or ventricular arrhythmia were studied in an open medication trial of fluoxetine, up to 60 mg/day, for 7 weeks. The main outcome measures were heart rate and rhythm measured by 24-hour ECG recordings, ejection fraction determined by radionuclide angiography, cardiac conduction intervals, and blood pressure. Baseline values were compared with those at weeks 2 and 7 of fluoxetine treatment. In 60 comparable patients, values of these same cardiovascular measures at baseline and after 3 weeks of treatment with a tricyclic antidepressant, nortriptyline, were also examined. RESULTS: Fluoxetine induced a statistically significant 6% decrease in heart rate, a 2% increase in supine systolic pressure, and a 7% increase in ejection fraction. There was no effect on cardiac conduction, ventricular arrhythmia, or orthostatic blood pressure. Overall, 4% of the fluoxetine patients had an adverse cardiovascular effect. In contrast, nortriptyline treatment caused a significant increase in heart rate and orthostatic hypotension, and 20% of the nortriptyline-treated patients had an adverse cardiovascular effect. CONCLUSIONS: In depressed patients with heart disease, fluoxetine treatment was not associated with the cardiovascular effects documented for the tricyclic antidepressants or with significant adverse cardiac events. However, limited conclusions about fluoxetine's cardiovascular effects and safety can be drawn from this study of only 27 patients monitored for 7 weeks.