II. Epidemiology
- Major Depression after Myocardial Infarction occurs in up to 50% of patients
- Major Depression after Myocardial Infarction is associated with increased cardiac events and higher mortality
III. Management: Pregnancy
- See Psychiatric Medications in Pregnancy
- Avoid medications during first trimester
- Electroconvulsive Therapy for severe Depression
IV. Management: Cardiovascular Disease (e.g. Coronary Artery Disease)
-
SSRI (Selective Serotonin Reuptake Inhibitor) preferred
- Sertraline (Zoloft)
- Escitalopram (Lexapro) 10 mg daily (avoid higher doses due to QT Prolongation risk)
- Citalopram (Celexa) max dose 20 mg (avoid higher doses due to QT Prolongation risk)
- Other agents to consider as adjunctive to SSRI
- Bupropion (risk of Hypertension)
- Venlafaxine (risk of Hypertension, esp. if dose >225 mg/day)
- Mirtazepine
- Adverse effects
- SSRI may increase GI Bleeding risk for those on Antiplatelet Therapy
- Consider GI prophylaxis (e.g. Prevacid) if other risks
- SSRI may increase GI Bleeding risk for those on Antiplatelet Therapy
-
SSRIs to avoid
- Avoid Fluoxetine (Prozac) with Beta Blockers
- Avoid Tricyclic Antidepressants
- Risk of hypotensive effect
- Potentially pro-arrhythmic effect
- Similar effect to Class I Antiarrhythmics
- Significant Drug Interactions
V. References
- (2018) Presc Lett 25(10): 55-56
- (2012) Presc Lett 19(10): 59
- Guck (2001) Am Fam Physician 64(4):641-8 [PubMed]
- Pathare (1997) BMJ 315:661-4 [PubMed]