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Cardiac Side Effects of Psychiatric Medications Scott R. Beach, M.D. Attending Psychiatrist, Massachusetts General Hospital Assistant Professor of Psychiatry, Harvard Medical School

Effects of Antidepressants on Blood Pressure, Heart Rate, and Other Cardiovascular Parameters

Tricyclic Antidepressants Tachycardia Muscarinic Hypotension Alpha-1 Huffman, J. C., Celano, C. M., & Januzzi, J. L. (2010). The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatric Disease and treatment, 6, 123.

Monoamine Oxidase Inhibitors Sympathomimetic agents Hypertensive crisis Tyramine-containing food Huffman, J. C., Celano, C. M., & Januzzi, J. L. (2010). The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatric Disease and treatment, 6, 123.

Selective Serotonin Reuptake Inhibitors Well established cardiac safety profile No major effects on blood pressure or heart rate Huffman, J. C., Celano, C. M., & Januzzi, J. L. (2010). The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatric Disease and treatment, 6, 123.

Paroxetine Paroxetine Coumadin Fluoxetine Tachycardia Bleeding risk More anticholinergic effects Little effect on the INR Decreased platelet aggregation Huffman, J. C., Celano, C. M., & Januzzi, J. L. (2010). The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatric Disease and treatment, 6, 123.

Monitor blood pressure Venlafaxine Hypertension Monitor blood pressure Huffman, J. C., Celano, C. M., & Januzzi, J. L. (2010). The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatric Disease and treatment, 6, 123.

Key Points Tricyclic antidepressants have been associated with increased heart rate and tachycardia as well as hypotension. Monoamine oxidase inhibitors can sometimes cause a hypertensive crisis when used in combination with certain foods or other medications. Some SSRIs may increase the risk of bleeding when used in combination with Coumadin.

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