Psychopharmacology in the treatment of patients with cardiovascular disease

Abstract

Cardiac illness is frequently comorbid with psychiatric disorders, and patients with heart disease are often prescribed psychotropic medications. Although psychotropics are in general well tolerated and efficacious in patients with cardiac disease, physicians need to be aware of key concerns related to side effects and safety. Among the antidepressants, selective serotonin reuptake inhibitors (SSRIs) have the most established track record for safety in cardiac patients, although atypical antidepressants, such as mirtazapine and bupropion, are also largely considered safe for use in these patients. Mood stabilizers, such as lithium and carbamazepine, have been associated with arrhythmias. Typical antipsychotics, such as haloperidol and chlorpromazine, increase the risk of QTc prolongation; however, the degree of such prolongation varies significantly among agents. Atypical antipsychotics, with the exception of ziprasidone, are considered safer in this regard, but some are associated with metabolic side effects that can increase the risk for coronary artery disease. The use of benzodiazepines is generally safe in patients with cardiac disease, and these agents may mitigate symptoms of acute coronary syndrome (ACS) by reducing catecholamine surges. Finally, stimulants, though relatively contraindicated in those with various heart conditions, may be used cautiously to rapidly treat depression and anergia in cardiac patients.