Antidepressants in patients with cardiovascular disease

As a result of demographic development the comorbidity of affective disorder and cardiovascular disease will get more important in the future. This assumption is based on the high prevalence of both depressive episodes and cardiovascular disease in elderly patients. In addition, it is known that depression is associated with a twofold to fourfold risk of morbidity and mortality for cardiovascular disease. As of yet, there are only few studies demonstrating therapeutic efficacy of the tricyclic antidepressant nortriptyline as well as of serotonin-reuptake-inhibitors, like paroxetine and sertraline, in depressive patients with concomitant coronary heart disease. Due to side effects on cordial functions of tricyclic agents (e.g. orthostatic hypotension, atrioventricular block, OT-prolongation, reduction of heart rate variability) SSRI are suitable to be recommended as agents of first choice. Moreover, it has been shown that SSRI might be valuable to improve long-term outcome in coronary heart disease by reduction of platelet aggregation. On the other side, epidemiological studies suggest an increased risk of haemorrhagic complications in long-term treatment with SSRI. Besides, for clinicians the knowledge of interactions of SSRI with medications relevant for treating cardiovascular disease (e.g. coumarine-derivates, calcium-antagonists, beta-blocker, amiodarone) is crucial to optimize anti-depressant treatment in patients with cardiovascular disease.