Antidepressants and cardiovascular adverse events: A narrative review

Background: major depression or deterioration of previous mood disorders is a commonadverse consequence of coronary heart disease, heart failure, and cardiac revascularizationprocedures. therefore, treatment of depression is expected to result in improvement of moodcondition in these patients. despite demonstrated effects of anti-depressive treatment in heartdisease patients, the use of some antidepressants have shown to be associated with someadverse cardiac and non-cardiac events. in this narrative review, the authors aimed to firstassess the findings of published studies on beneficial and also harmful effects of different typesof antidepressants used in patients with heart diseases. finally, a new categorization forselecting antidepressants according to their cardiovascular effects was described.methods: using pubmed, web of science, scopus, index copernicus, cinahl, andcochrane database, we identified studies designed to evaluate the effects of depression and alsousing antidepressants on cardiovascular outcome. a 40 studies were finally assessedsystematically. among those eligible studies, 14 were cohort or historical cohort studies, 15 wererandomized clinical trial, 4 were retrospective were case-control studies, 3 were meta-analysesand 2 animal studies, and 2 case studies.results: according to the current review, we recommend to divide antidepressants into threecategories based on the severity of cardiovascular adverse consequences including (1) the safestdrugs including those drugs with cardio-protective effects on ventricular function, as well ascardiac conductive system including selective serotonin reuptake inhibitors, (2) neutralized drugswith no evidenced effects on cardiovascular system including serotonin–norepinephrine reuptakeinhibitors, and (3) harmful drugs with adverse effects on cardiac function, hemodynamic stability,and heart rate variability including tricyclic antidepressants, serotonin antagonist and reuptakeinhibitors, and noradrenergic and specific serotonergic antidepressants.conclusion: the presented categorization of antidepressants can be clinically helpful to havethe best selection for antidepressants to minimizing their cardiovascular harmful effects.