Treatment of Depression in Patients with Concomitant Cardiac Disease

• Published in: Progress in cardiovascular diseases Vol. 58; no. 5; pp. 514 - 528
• Main Authors: Teply, Robyn M, Packard, Kathleen A, White, Nicole D, Hilleman, Daniel E, DiNicolantonio, James J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2016
• Subjects: Affect - drug effects; Antidepressant; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Arrhythmia; Cardiovascular; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Cardiovascular System - drug effects; Cardiovascular System - physiopathology; Comorbidity; Depression - diagnosis; Depression - drug therapy; Depression - mortality; Depression - psychology; Drug Interactions; Heart Diseases - diagnosis; Heart Diseases - drug therapy; Heart Diseases - mortality; Heart Diseases - physiopathology; Heart failure; Humans; Hypertension; Ischemic heart disease; Patient Selection; Polypharmacy; Risk Assessment; Risk Factors; Treatment Outcome; CREATE; cognitive behavior therapy; IPT; proton pump inhibitor; interleukin-6; Hamilton Rating Scale for Depression; electrocardiogram; ENRICHD; diastolic blood pressure; sertraline treatment of major depression in patients with acute MI or unstable angina trial; left ventricular; NYHA; blood pressure; AF; IL-6; MHRA; CGI-I; The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy trial; CVD; AV; GDS-4; HPA; Clinical Global Impression Improvement scale; Geriatric Depression Scale; HAM-D; Myocardial Infarction and Depression Intervention trial; FDA; BDI; milligram; PPI; MAOI; BP; Ischemic heart disease; cytochrome; acute coronary syndrome; cardiovascular disease; hypothalamic-pituitary-adrenal; ventricular fibrillation; ECG; cardiovascular; ACS; CV; VEA; major depressive disorder; coronary heart disease; CHD; C-reactive protein; Arrhythmia; low-perceived social support; myocardial infarction; LVEF; LV; MDD; ADP; systolic blood pressure; left ventricular ejection fraction; New York Heart Association; atrial fibrillation; DBP; adenosine diphosphate; CYP; MI; Food and Drug Administration; heart failure; orthostatic hypotension; Enhancing Recovery in Coronary Heart Disease trial; American Heart Association; gastrointestinal; VF; SSRI; TCA; Mg; MIND-IT; premature ventricular complex; CRP; Antidepressant; SADHART; HTN; NS; noradrenergic and serotonergic; serotonin norepinephrine reuptake inhibitors; LPSS; interpersonal psychotherapy; sudden cardiac death; INR; international normalized ratio; CBT; selective serotonin reuptake inhibitors; tricyclic antidepressant; OH; SBP; GI; British Medicines and Healthcare Products Regulatory Agency; DECARD; Depression in Patients with Coronary Artery Disease trial; monoamine oxidase inhibitor; atrioventricular; SNRI; SCD; ventricular ectopic activity; AHA; PVC; hypertension; HF; Beck Depression Inventory; Heart failure; Hypertension
• ISSN: 0033-0620; 1532-8643; 1873-1740
• DOI: 10.1016/j.pcad.2015.11.003

Abstract Depressed patients are at increased risk of cardiovascular (CV) disease (CVD) and those with concomitant depression and CVD are at increased risk of death. The safety and efficacy of antidepressants in patients with CVD varies greatly between the agent used and type of disease. This review will summarize the CV adverse effect and drug interaction profile of antidepressants and discuss the use of antidepressants in CVD patients. We searched MEDLINE, PubMed, CINAHL, Web of Science, PsycINFO, and The Cochrane Library from inception to June 2014 to identify studies relevant to antidepressant use in patients with CVD. Primary references from the identified articles were also evaluated for inclusion. Descriptive analysis was performed for the included studies in this review. Orthostatic hypotension was more common with tricyclic antidepressants (TCAs), trazodone and monoamine oxidase inhibitors (MAOIs). Hypertension can be significant with serotonin norepinephrine reuptake inhibitors (SNRIs) and MAOIs. The potential for QT prolongation is present with TCAs, certain selective serotonin reuptake inhibitors (SSRIs), certain SNRIs and mirtazapine. Due to its low risk of drug-drug interactions, adverse effect profile and potential for beneficial antiplatelet activity, sertraline could be considered the choice antidepressant for patients with ischemic heart disease. SSRIs and potentially SNRIs are relatively safe and effective options for patients with heart failure. In patients at high risk for ventricular arrhythmias, bupropion has the overall lowest risk for QT prolongation. TCAs and MAOIs should be avoided in patients with concomitant CVD. In conclusion, due to the increased morbidity and mortality associated with comorbid CVD and depression, practitioners should readily assess and initiate management of depression in such patients. The choice of antidepressant should take into account the potential CV impact of the various agents balancing safety and efficacy.