Clinical use of antidepressant therapy and associated cardiovascular risk

Abstract

A number of different psychotropic agents have been associated with an increased risk of cardiovascular disease, and these relationships have been difficult to interpret due to the presence of confounding factors. Recently, there has been renewed interest in the potential for certain antidepressants to cause QT prolongation, which is a predisposing factor for arrhythmia. However, the optimum means of determining QT remains contentious due to discrepancies between methods that may be readily applied in a clinical setting versus more detailed techniques during regulatory assessment. A number of different pharmacological mechanisms might explain the occurrence of adverse cardiac effects, and these differ according to the type of antidepressant agent. Emerging data indicate that citalopram exhibits a dose-effect relationship for QT prolongation. Whereas cardiotoxicity is readily apparent in the context of intentional antidepressant overdose, the occurrence of cardiac effects as a result of therapeutic administration is less certain. Pre-existing cardiac disease and other factors that independently predispose to arrhythmia are important considerations. Therefore, clinical judgment is needed to evaluate the overall risk or benefit of a particular antidepressant in any patient. Close monitoring should be considered for those at greatest risk of QT prolongation and arrhythmia.

Depressive Symptom Clusters as Predictors of Incident Coronary Artery Disease

“…A final limitation is that we did not obtain data regarding antidepressant use from this cohort. Thus, we cannot determine whether the use of antidepressants with known adverse cardiovascular effects, such as tricyclic antidepressants (34), is partially responsible for the observed relationship between depressive symptoms and incident CAD events.…”

Physical activity and exercise in the treatment of depression

“…In those patients who do demonstrate improvements in depressive symptoms with antidepressant therapies, a time-lag in the onset of therapeutic effects is frequently reported. Antidepressant drugs are associated with adverse side effects (Agency for Health Research and Quality (AHRQ), 2012) and an increased risk of cardiovascular disease, particularly in those with pre-existing cardiovascular conditions or major cardiovascular risk factors (Waring, 2012). Furthermore, adherence to antidepressant medications is often poor and patients often prematurely discontinue their antidepressant therapy; it has been suggested that approximately 50% of psychiatric patients and 50% of primary care patients are non-adherent when assessed 6-months after the initiation of treatment (Sansone and Sansone, 2012).…”

New Screening System for Selective Blockers of Voltage-Gated K+ Channels Using Recombinant Cell Lines Dying Upon Single Action Potential

“…It has been, however, reported that citalopram may lead to cardiovascular risk, for example QT prolongation, within the clinical concentration range (26), whereas the relation between Kv1.5 inhibition and QT prolongation is not completely clear. The IC 50 value of citalopram for Kv1.5 obtained by the post-ES viability assay (1.5 mM) was comparable to that determined electrophysiologically in the precedent study (2.8 mM) (17) but slightly lower than that obtained electrophysiologically in this study (at the pulse end: 7.48 mM).…”