No abstract

Background: Among women worldwide, major depression (MDD) and heart disease rank first and second, respectively, in burden of disease. Although selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed, possible inhibition of nitric oxide (NO) function has caused concerns about their effects on protective vascular mechanisms. Our study aimed to determine the effect of SSRIs on flow-mediated vascular dilatation (FMD), platelet aggregation, and platelet NO production among women. Methods: Women (n = 28) without known cardiovascular disease were recruited prior to undergoing SSRI treatment for MDD, postpartum depression (PPD), or premenstrual dysphoric disorder (PMDD). Symptoms were quantified using the Hamilton Depression/Anxiety and Beck Depression scales. FMD, platelet aggregation, and platelet NO production were measured before and after 1 month of SSRI (sertraline, fluoxetine, or paroxetine) therapy. Results: Depression and anxiety symptoms decreased significantly with SSRI treatment ( ps < 0.01). FMD and platelet aggregation did not differ between pre-and posttreatment, although FMD rose to the normal range ( ‡ 8%) in two of three women with abnormal FMD prior to SSRI treatment. We observed a 21% decrease ( p = 0.024) in platelet NO production. Conclusions: SSRI treatment had little effect on FMD or platelet aggregation. The health impact of decreased NO production is unclear, particularly in this relatively young group of women without cardiovascular disease, but should be considered in future studies focusing on SSRI safety in patients with cardiovascular disease.

In conducting drug trials nowadays one is aware of at least some of the difficulties that have to be faced and the possible traps lying ahead. It is probably true to say that perfection is unattainable in trials of this nature because of the unpredictability of the human material concerned—both the tested and the observers sharing this common fallibility. It is necessary to attempt so to arrange the experiment that the magnitude of the errors is kept to a minimum and the results remain unobscured.

A double-blind controlled trial of iproniazid in endogenous depression and a comparison of its effects with those of E.C.T. was reported in this journal by Kiloh et al. (1960). To summarize the results—of 26 patients treated with iproniazid a good immediate response was found in 14 cases (54 per cent.) whereas only 3 of 28 patients (11 per cent.) given placebo tablets showed a significant improvement at the end of three weeks. Of 27 patients treated with E.C.T. 24 (89 per cent.) showed a good immediate response.