Clinical use of antidepressant therapy and associated cardiovascular risk
Open Access
- 1 August 2012
- journal article
- Published by Taylor & Francis Ltd in Drug, Healthcare and Patient Safety
- Vol. 4, 93-101
- https://doi.org/10.2147/DHPS.S28804
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.Keywords
This publication has 88 references indexed in Scilit:
- Citalopram induced torsade de pointes, a rare life threatening side effectInternational Journal of Cardiology, 2008
- Impaired heart rate variability and altered cardiac sympathovagal balance after antidepressant overdoseEuropean Journal of Clinical Pharmacology, 2008
- Citalopram overdose: Late presentation of torsades de pointes (TdP) with cardiac arrestJournal of Medical Toxicology, 2008
- Drug‐induced torsades de pointes: a review of the Swedish pharmacovigilance databasePharmacoepidemiology and Drug Safety, 2008
- Vascular reactivity, 5-HT uptake, and blood pressure in the serotonin transporter knockout ratAmerican Journal of Physiology-Heart and Circulatory Physiology, 2008
- Outcomes after Isolated Mirtazapine (Remeron™) Supratherapeutic IngestionsThe Journal of Emergency Medicine, 2008
- QT Prolongation and delayed atrioventricular conduction caused by acute ingestion of trazodoneClinical Toxicology, 2008
- Torsade de Pointes during Combined Treatment with Risperidone and CitalopramPharmacopsychiatry, 2007
- Drug-induced QT prolongation and torsades de pointes: evaluation of a QT nomogramQJM: An International Journal of Medicine, 2007
- Acute myocarditis after massive phenelzine overdoseEuropean Journal of Clinical Pharmacology, 2007