Pharmacologic Treatment of Depression in Patients With Heart Disease
Abstract
The relationship between depression and cardiovascular disease is complex and multifaceted. There is a growing body of evidence that depression significantly and adversely affects cardiovascular health. Perhaps the most prominent finding is the documented increase in mortality rate in patients with depression after myocardial infarction. The critical questions of interest to both the clinician and researcher are whether there are safe and effective treatments for depression in patients with heart disease and whether treatment of depression reduces the increased risk of cardiac morbidity and mortality. Although the data are limited and are primarily from open or comparator trials, the tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRI) are effective for treatment of depression in patients with ischemic heart disease (IHD), and response rates are comparable with those reported in depressed patients without heart disease. In terms of safety, the TCAs are associated with documented adverse cardiovascular effects, including increases in heart rate, orthostatic hypotension, and conduction delays. Use of TCAs in patients with IHD carries a proven increased risk of cardiac morbidity and perhaps of mortality as well. The SSRI appear to be relatively safe and effective in the treatment for depression in patients with comorbid IHD. TCA = tricyclic antidepressant; MI = myocardial infarction; IHD = ischemic heart disease; CAST = Cardiac Arrhythmia Suppression Trial; SADHART = Sertraline Antidepressant Heart Attack Randomized Trial; HRSD = Hamilton Rating Scale for Depression; SSRI = selective serotonin reuptake inhibitor.
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TCAs' higher anticholinergic property may be the major cause of cardiovascular side effects.
“Mechanism behind cardiovascular side effect is very complicated, but TCAs' higher anticholinergic property may be the major cause.29”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [29]
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- Authors
- Roose, S. P., & Miyazaki, M.
- Affiliations
- Columbia University (US)
- New York State Psychiatric Institute (US)
- Corresponding author
- Roose, Steven P.
- Venue
- Psychosomatic Medicine
- Published
- 2005-05
- Volume
- 67
- Pages
- S54-S57
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2044674965
- Cited by
- 76
- References
- 28
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 1 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 2 · 2013: 5 · 2012: 5
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, heart disease, ischemic heart disease, tricyclic antidepressants, selective serotonin reuptake inhibitors, antidepressant safety, cardiovascular adverse events, myocardial infarction, cardiac mortality, cardiac arrhythmias, orthostatic hypotension, conduction delay, comorbidities
- MeSH terms
- Antidepressive Agents, Antidepressive Agents, Tricyclic, Cardiovascular Diseases, Depression, Heart Rate, Humans, Treatment Outcome, Myocardial Ischemia, Selective Serotonin Reuptake Inhibitors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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