Cardiovascular Adverse Reactions During Antidepressant Treatment: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2010
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BACKGROUND: Antidepressants (ADs) are known to have the potential to cause various cardiovascular adverse drug reactions (ADRs). The tricyclic antidepressants (TCAs) were first revealed to be a possible source of cardiovascular ADRs. In recent years, newer classes of ADs were also suggested to have a higher risk of cardiovascular adverse effects. In particular, the selective serotonin reuptake inhibitors (SSRIs) were suspected to have the potential to induce QTc interval prolongation, and therefore increase the risk of ventricular arrhythmia. This descriptive study is based on the continuous pharmacovigilance program of German-speaking countries (Austria, Germany, and Switzerland), the Arzneimittelsicherheit in der Psychiatrie (AMSP), which assesses severe ADRs occurring in clinical routine situations. METHODS: Of 169,278 psychiatric inpatients treated with ADs between 1993 and 2010, 198 cases of cardiovascular ADRs (0.12%) were analyzed. RESULTS: Our study showed that the incidence rates of cardiovascular ADRs were highest during treatment with monoamine oxidase inhibitors (0.27%), TCAs (0.15%), and serotonin noradrenaline reuptake inhibitors (0.14%); the risk of occurring during treatment with SSRIs (0.08%) was significantly lower. The noradrenergic and specific serotonergic AD mirtazapine (0.07%) had a significantly lower risk of cardiovascular ADRs than all other ADs. Severe hypotension was the most frequent ADR, followed by hypertension, arrhythmia, and in some rare cases heart failure. CONCLUSIONS: Despite certain limitations due to the AMSP study design, our observations on cardiovascular ADRs can contribute to a better knowledge of the cardiovascular risk profiles of antidepressants in the clinical routine setting. However, prospective studies are needed to verify our findings.
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Hypertension associated with SSRIs was very rare.
“In contrast, hypertension associated with SSRIs was very rare.”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [26]
A descriptive study based on pharmacovigilance programs of German-speaking countries found overall cardiovascular adverse reactions were higher for TCAs (0.15%) and SNRIs than SSRIs (0.08%).
“The overall cardiovascular adverse reactions were higher for TCAs (0.15%) and SNRIs than SSRIs (0.08%).”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [26]
Mirtazapine (0.07%) had a significantly lower risk of cardiovascular adverse events.
“The noradrenergic and specific serotonergic antidepressant mirtazapine (0.07%) had a significantly lower risk of cardiovascular adverse events.”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [26]
In terms of hypertension, SNRIs showed a significantly higher risk (p<0.001) than other antidepressants did.
“In terms of hypertension, SNRIs showed a significantly higher risk (p<0.001) than other antidepressants did.”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [26]
Among SNRIs, venlafaxine (incidence rate 0.05%, median dosage 150 mg/day) had a significantly higher risk of hypertension (p<0.001).
“Among SNRIs, venlafaxine (incidence rate 0.05%, median dosage 150 mg/day) was revealed to have a significantly higher risk of hypertension (p<0.001).”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [26]
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Self-citation
- Authors
- Spindelegger, C. J., Papageorgiou, K., Grohmann, R., Engel, R., Greil, W., Konstantinidis, A., Agelink, M. W., Bleich, S., Ruether, E., Toto, S., & Kasper, S.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Kasper, S.
- Venue
- International Journal of Neuropsychopharmacology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-31
- Volume
- 18
- Issue
- 4
- Pages
- pyu080-pyu080
- ISSN
- 1461-1457 (ISSN-L)
- 1469-5111
- PMC
- PMC4360213
- OpenAlex
- W2129478148
- Cited by
- 82
- References
- 53
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 9 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 9 · 2019: 11 · 2018: 11 · 2017: 9 · 2016: 8 · 2015: 2
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- The International Journal of Neuropsychopharmacology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- antidepressants, tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, serotonin-norepinephrine reuptake inhibitors, mirtazapine, QTc prolongation, ventricular arrhythmias, hypotension, hypertension, heart failure, pharmacovigilance, psychiatric inpatients
- MeSH terms
- Aged, Antidepressive Agents, Austria, Cardiovascular Diseases, Female, Germany, Humans, Male, Middle Aged, Switzerland, Incidence, Adverse Drug Reaction Reporting Systems
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