Considerations for the use of antidepressants in patients with cardiovascular disease

There is convincing evidence that depression can significantly and adversel y affect cardiovascular health and increase mortality rates in patients wit h documented ischemic heart disease. it is unknown whether treatment of dep ression can reduce the risk of IHD or if treatment can decrease mortality r ates after myocardial infarction. Nonetheless, the available evidence stron gly suggests that depression in patients with cardiovascular disease should be treated. Tricyclic antidepressants had been considered acceptable for u se in patients with ischemic heart disease until data from the Cardiac Arrh ythmia Suppression Trial (CAST) demonstrated a significantly increased mort ality rate after myocardial infarction in patients treated with type I anti arrhythmics. Because tricyclic antidepressants are type IA antiarrhythmics, they presumably carry a risk similar to that of moricizine in patients wit h ischemic disease. The limited but growing data available on the use of se lective serotonin reuptake inhibitors and bupropion in patients with cardia c disorders suggest that these agents are safer antidepressant treatment al ternatives. Larger, long-term, randomized, controlled studies are needed to confirm that selective serotonin reuptake inhibitors are indeed safe in de pressed patients with cardiovascular disease.