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

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

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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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