Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach

Abstract

Patients with schizophrenia (SCZ) are at high risk of cardiovascular disease (CVD) due to an inherited predisposition, a sedentary life style and the use of antipsychotic medications. Several approaches have been taken to minimize this risk but results continue to be unsatisfactory. A potential alternative is prescribing selective serotonin reuptake inhibitors (SSRIs). SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression. We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ. A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ. Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine. Two of those studies found improvements with fluvoxamine. Of the other two reports, one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol, low-density lipoprotein and triglyceride. The second report suggests that when SSRIs are combined with antipsychotics, the metabolic impact depends on the antipsychotic prescribed. While there are promising results, no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ. Further studies are needed to resolve this matter.

The Influence of Antipsychotic Treatment on the Activity of Abzymes Targeting Myelin and Levels of Inflammation Markers in Patients with Schizophrenia

“…According to the data obtained from positron emission tomography, in vitro and in vivo animal modeling, and post-mortem brain tissue studies, aberrant glutamate–dopamine synaptic and intracellular signaling interactions are central to the pathogenesis of schizophrenia [ 1 , 2 ]. Molecular abnormalities in the nervous [ 1 ], immune [ 3 ], and endocrine systems [ 4 , 5 ], and metabolic processes [ 6 , 7 ] also play an important role in the pathophysiology of the disease. Accumulating evidence also indicates that immunoinflammation may be involved in the pathogenesis of schizophrenia.…”

Examining the Association Between Serotonergic Antidepressants and Blood Transfusion Requirements in Orthopaedic Surgery: A Comprehensive Analysis

“…The serotonin release in platelets plays a crucial role in their aggregation process [ 10 ]. Platelets lack the ability to engage in serotonin synthesis, instead relying on serotonin transporters to uptake serotonin from the bloodstream [ 11 ]. SSRIs exert their pharmacological effects by inhibiting the reuptake of serotonin transporters, hence reducing the concentration of serotonin inside platelets during a prolonged course of therapy [ 12 ].…”