II. Epidemiology

  1. Major Depression after Myocardial Infarction occurs in up to 50% of patients
  2. Major Depression after Myocardial Infarction is associated with increased cardiac events and higher mortality

III. Management: Pregnancy

  1. See Psychiatric Medications in Pregnancy
  2. Avoid medications during first trimester
  3. Electroconvulsive Therapy for severe Depression

IV. Management: Cardiovascular Disease (e.g. Coronary Artery Disease)

  1. SSRI (Selective Serotonin Reuptake Inhibitor) preferred
    1. Sertraline (Zoloft)
    2. Escitalopram (Lexapro) 10 mg daily (avoid higher doses due to QT Prolongation risk)
    3. Citalopram (Celexa) max dose 20 mg (avoid higher doses due to QT Prolongation risk)
  2. Other agents to consider as adjunctive to SSRI
    1. Bupropion (risk of Hypertension)
    2. Venlafaxine (risk of Hypertension, esp. if dose >225 mg/day)
    3. Mirtazepine
  3. Adverse effects
    1. SSRI may increase GI Bleeding risk for those on Antiplatelet Therapy
      1. Consider GI prophylaxis (e.g. Prevacid) if other risks
  4. SSRIs to avoid
    1. Avoid Fluoxetine (Prozac) with Beta Blockers
  5. Avoid Tricyclic Antidepressants
    1. Risk of hypotensive effect
    2. Potentially pro-arrhythmic effect
      1. Similar effect to Class I Antiarrhythmics
    3. Significant Drug Interactions

V. References

  1. (2018) Presc Lett 25(10): 55-56
  2. (2012) Presc Lett 19(10): 59
  3. Guck (2001) Am Fam Physician 64(4):641-8 [PubMed]
  4. Pathare (1997) BMJ 315:661-4 [PubMed]

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