Official websites use. Share sensitive information only on official, secure websites. Author Contributions : All authors contributed to the review and to the writing of the manuscript. Address for correspondence: Robert M. Phone: Fax: Depression is common in older adults and those with cardiovascular disease. Although serotonin reuptake inhibitors SSRIs generally have been shown to be safe to treat depression in these patients, it is important to identify additional antidepressants when SSRIs are not effective.
This qualitative narrative review summarizes what is known about the cardiovascular side effects of some of the newer antidepressants. Twelve novel non-SSRI antidepressants were identified from the literature: venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran, mirtazapine, bupropion, vilazodone, vortioxetine, agomelatine, moclobemide, and ketamine-esketamine. The recommended use, dosing-ranges, cardiovascular effects and general advantages and disadvantages of each of the drugs are discussed.
Levomilnacipran and vilazodone have not received enough study to judge their safety in older patients or in those with, or at high risk for, cardiovascular disease. There is at least some evidence for possible adverse events with each of the other newer antidepressants that could be of concern in these patients. Nevertheless, with careful administration and attention to the potential adverse reactions for each drug, these may provide safe, effective alternatives for older adults and patients with cardiovascular disease who do not respond to SSRI antidepressants.
However, more research on the safety and efficacy of these drugs in these specific patient populations is urgently needed. Depression is common in medically vulnerable populations, including older adults and those with chronic medical illnesses such as cardiovascular disease.
In addition to its negative effect on the quality of life, depression is associated with an increased risk for medical morbidity in persons with heart disease. However, some antidepressants have cardiovascular side-effects that may add to rather than reduce the risk for cardiac events. Tricyclic antidepressants TCAs , for example, can cause orthostatic hypotension, slowed cardiac conduction, increased heart rate and decreased heart rate variability.
