Antidepressant drugs and the cardiovascular system

This article reviews the cardiovascular effects of antidepressants drugs. Tricyclic antidepressants (TCAs) have the most significant cardiovascular side effects of any of the antidepressant agents. TCA side effects may be particularly burdensome or even life-threatening in patients with preexisting cardiovascular disease. Orthostatic hypotension is the most common cardiovascular side effect, and conduction disturbances and ventricular arrhythmias are the most life-threatening ones. TCAs' quinidine-like effects account for these conduction and rhythm disturbances. Monoamine oxidase inhibitors (MAOIs) commonly induce orthostatic hypotension. Hypertensive crises and the serotonin syndrome are the most serious problems associated with MAOI administration. MAOIs require dietary and concomitant drug restrictions to minimize adverse effects. Rarely, spontaneous severe hypertension may occur during MAOI administration. Bupropion administration may increase patients' blood pressure, particularly in those with preexisting hypertension. Trazodone may provoke ventricular arrhythmias. Nefazodone and the selective serotonin reuptake inhibitors (SSRIs) may contribute to drug-drug interactions that have significant cardiovascular adverse effects as a part of those interactions. Also, concomitant administration of SSRIs and MAOIs may produce the serotonin syndrome and vasomotor instability. Venlafaxine may increase supine diastolic blood pressure. According to the manufacturer, subjects taking this agent require blood pressure monitoring. Considering what we know about all antidepressants, periodic blood pressure assessment should be a routine part of the practice of psychiatry.