Title:Safety Limits of Antidepressant Use Plus Combinations: Focus on Cardiovascular Function
VOLUME: 19 ISSUE: 8
Author(s):Florindo Stella, Julia C. Loureiro, Marcos V. Pais, Paulo R. Canineu and Orestes V. Forlenza*
Affiliation:Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP
Keywords:Antidepressants, QTc prolongation, ECG abnormalities, cardiovascular disorders, adult-old patients, aging.
Abstract:Background: Antidepressants have been widely prescribed for depression, anxiety, sleep disorders, and in
the management of behavioural symptoms of adult-old patients. Although generally safe, newer generation antidepressants
are not devoid of the risk of inducing clinically relevant adverse events.
Objectives: To investigate the association between newer generation antidepressants and the occurrence of cardiovascular
adverse events and electrocardiogram (ECG) abnormalities.
Method: Studies were included in the review according to the following criteria: a) clinical trials (placebo-controlled
or not) or case reports; b) short- or long-term interventions with antidepressants; c) prescription of newer generation
antidepressants as first-line treatment; d) samples of adult or adult-old patients. From a total of 301 articles addressing
the association between antidepressants and cardiovascular adverse events as primary or secondary outcomes, we
selected 30 controlled clinical trials and 10 case reports.
Results: In most clinical studies, the effects of antidepressants on cardiac function are usually computed as secondary
outcome variables, however with limited information. Conversely, case reports tend to present more comprehensive
sets of clinical and laboratorial parameters, but the generalization of such data is limited by the small number of
observations. The occurrence of QTc prolongation (with increased risk of torsade de pointes) has been reported.
Aging, higher dosages of antidepressants, drug interaction, and pre-existing cardiovascular comorbidities were found
as risk factors for the aforementioned cardiovascular and ECG abnormalities.
Conclusion: Prescribing antidepressants requires caution given their potential impact on cardiac function, and the
clinician should carefully monitor cardiovascular and ECG parameters particularly in cases with underlying heart
disease.
