Treatment of depression in patients with heart disease

Patients with depression are more likely than patients without depression t o develop ischemic heart disease and suffer cardiac-related death. Recent e vidence suggests that the association between depression and increased card iac mortality may in part be due to an increase in platelet activity and an imbalance in sympathetic and parasympathetic activity that makes the patie nt more susceptible to ventricular fibrillation. Available data suggest tha t the tricyclic antidepressants (TCAs) may increase the risk of mortality i n patients with ischemic heart disease. Three studies with the selective se rotonin reuptake inhibitors (SSRIs), including a double-blind, randomized c omparison of paroxetine with nortriptyline, support the conclusion that the SSRIs have a relatively benign cardiovascular profile. Therefore, they are preferable to the TCAs for treatment of depression in patients at risk for cardiac events. Additional studies are needed to definitively establish th e cardiovascular safety of the SSRIs.