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Cardiovascular Adverse Effects of Psychotropic Drugs

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Brain and Heart Dynamics

Abstract

The cardiovascular adverse effects that may occur during treatment with the different categories of psychotropic drugs and the differences between single drugs within each category are reviewed. The main adverse reactions reported during psychotropic drug treatments are, in order of prevalence, (1) arrhythmias, since antidepressants and neuroleptics affect several ion channels involved in the control of cardiac action potentials and thus exert a proarrhythmic activity; (2) changes in blood pressure; (3) impairment of ventricular function; and (4) thromboembolism. Benign arrhythmias and orthostatic hypotension are the most common and most manageable adverse effects. Arrhythmias, including torsades de pointes, and impairment of ventricular function may lead to sudden death whose odds ratio for the antipsychotics ranges between 1.72 for quetiapine and 3.67 for clozapine. The risk of cardiovascular adverse effects is higher for the typical antipsychotics than for the atypical. Among the latter, clozapine prescription requires particular attention. Tricyclic antidepressants and lithium are frequently accompanied by dysrhythmias, including QT interval prolongation, but sudden death is a rare event. A marginal risk of myocardial infarction during antidepressant therapy exists, but the risk of cardiovascular adverse effects with non-tricyclic antidepressants is remarkably low and practically nonexistent for the mood modifiers, except lithium and anxiolytics.

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Abbreviations

ANS:

Autonomic nervous system

CI:

Confidence interval

CL:

Confidence limits

CVD:

Cardiovascular disease

ECG:

Electrocardiography

EEG:

Electroencephalography

HDL:

High-density lipoprotein

LDL:

Low-density lipoproteins

NASSA:

Noradrenergic and specific serotonergic antidepressant

OR:

Odds ratio

QTc:

QT interval corrected for heart rate according to Bazzett procedure

SD:

Standard deviations

SE:

Standard error

SMD:

Severe mental disorders

SNRI:

Selective noradrenaline reuptake inhibitors

SSRI:

Selective serotonin reuptake inhibitors

TCA:

Tricyclic antidepressants

TdP:

Torsades de pointes

References

  1. AIFA – National Report on Medicines use in Italy 2016. n.d.

    Google Scholar 

  2. Shen WW. A history of antipsychotic drug development. Compr Psychiatry. 1999;40:407–14. https://doi.org/10.1016/S0010-440X(99)90082-2.

    Article  CAS  PubMed  Google Scholar 

  3. Kelly HG, Fay JE, Laverty SG. Thioridazine hydrochloride (Mellaril): its effect on the electrocardiogram and a report of two fatalities with electrocardiographic abnormalities. JAMA J Am Med Assoc. 1963;186: 221. https://doi.org/10.1001/jama.1963.03710030141099.

    Article  Google Scholar 

  4. Hollister LE, Kosek JC. Sudden death during treatment with phenothiazine derivatives. JAMA J Am Med Assoc. 1965;192:1035–8. https://doi.org/10.1001/jama.1965.03080250013003.

    Article  CAS  Google Scholar 

  5. McLean G, Martin JL, Martin DJ, Guthrie B, Mercer SW, Smith DJ. Standard cardiovascular disease risk algorithms underestimate the risk of cardiovascular disease in schizophrenia: evidence from a national primary care database. Schizophr Res. 2014;159:176–81. https://doi.org/10.1016/j.schres.2014.07.022.

    Article  PubMed  Google Scholar 

  6. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications. JAMA Psychiatry. 2015;72:334. https://doi.org/10.1001/jamapsychiatry.2014.2502.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both. Br J Psychiatry. 2013;202:22–7. https://doi.org/10.1192/bjp.bp.112.112169.

    Article  Google Scholar 

  8. Chung K-H, Chen P-H, Kuo C-J, Tsai S-Y, Huang S-H, Wu W-C. Risk factors for early circulatory mortality in patients with schizophrenia. Psychiatry Res. 2018;267:7–11. https://doi.org/10.1016/j.psychres.2018.05.044.

    Article  PubMed  Google Scholar 

  9. Andreassen OA, Djurovic S, Thompson WK, Schork AJ, Kendler KS, O’Donovan MC, et al. Improved detection of common variants associated with schizophrenia by leveraging pleiotropy with cardiovascular-disease risk factors. Am J Hum Genet. 2013;92:197–209. https://doi.org/10.1016/j.ajhg.2013.01.001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Lawrence D, Kisely S. Review: inequalities in healthcare provision for people with severe mental illness. J Psychopharmacol. 2010;24:61–8. https://doi.org/10.1177/1359786810382058.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Feinstein RE. Cardiovascular effects of novel antipsychotic medications. Heart Dis. 2002;4:184–90.

    Article  CAS  Google Scholar 

  12. Mackin P. Cardiac side effects of psychiatric drugs. Hum Psychopharmacol Clin Exp. 2008;23:S3–14. https://doi.org/10.1002/hup.915.

    Article  CAS  Google Scholar 

  13. Timour Q, Frassati D, Descotes J, Chevalier P, Christé G, Chahine M. Sudden death of cardiac origin and psychotropic drugs. Front Pharmacol. 2012;3:76. https://doi.org/10.3389/fphar.2012.00076.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Manolis TA, Manolis AA, Manolis AS. Cardiovascular safety of psychiatric agents: a cautionary tale. Angiology. 2018. https://doi.org/10.1177/0003319718780145.

  15. Meyer JM. Novel antipsychotics and severe hyperlipidemia. J Clin Psychopharmacol. 2001;21:369–74.

    Article  CAS  Google Scholar 

  16. Buckley NA, Sanders P. Cardiovascular adverse effects of antipsychotic drugs. Drug Saf. 2000;23: 215–28.

    Article  CAS  Google Scholar 

  17. Salvo F, Pariente A, Shakir S, Robinson P, Arnaud M, Thomas S, et al. Sudden cardiac and sudden unexpected death related to antipsychotics: a meta-analysis of observational studies. Clin Pharmacol Ther. 2016;99:306–14. https://doi.org/10.1002/cpt.250.

    Article  CAS  PubMed  Google Scholar 

  18. Schmedt N, Kollhorst B, Enders D, Jobski K, Krappweis J, Garbe E, et al. Comparative risk of death in older adults treated with antipsychotics: a population-based cohort study. Eur Neuropsychopharmacol. 2016;26:1390–400. https://doi.org/10.1016/j.euroneuro.2016.07.006.

    Article  CAS  PubMed  Google Scholar 

  19. Mehtonen OP, Aranko K, Mälkonen L, Vapaatalo H. A survey of sudden death associated with the use of antipsychotic or antidepressant drugs: 49 cases in Finland. Acta Psychiatr Scand. 1991;84:58–64.

    Article  CAS  Google Scholar 

  20. Reilly JG, Ayis SA, Ferrier IN, Jones SJ, Thomas SHL. Thioridazine and sudden unexplained death in psychiatric in-patients. Br J Psychiatry. 2002; 180:515–22.

    Article  CAS  Google Scholar 

  21. Coulter DM, Bate A, Meyboom RH, Lindquist M, Edwards IR. Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study. BMJ. 2001;322:1207–9.

    Article  CAS  Google Scholar 

  22. Kilian JG, Kerr K, Lawrence C, Celermajer DS. Myocarditis and cardiomyopathy associated with clozapine. Lancet. 1999;354:1841–5.

    Article  CAS  Google Scholar 

  23. De Berardis D, Rapini G, Olivieri L, Di Nicola D, Tomasetti C, Valchera A, et al. Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine. Ther Adv Drug Saf. 2018;9:237–56. https://doi.org/10.1177/2042098618756261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Yuen JWY, Kim DD, Procyshyn RM, White RF, Honer WG, Barr AM. Clozapine-induced cardiovascular side effects and autonomic dysfunction: a systematic review. Front Neurosci. 2018;12:203. https://doi.org/10.3389/fnins.2018.00203.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ronaldson KJ, Fitzgerald PB, Taylor AJ, Topliss DJ, McNeil JJ. A new monitoring protocol for clozapine-induced myocarditis based on an analysis of 75 cases and 94 controls. Aust N Z J Psychiatry. 2011;45: 458–65. https://doi.org/10.3109/00048674.2011.572852.

    Article  PubMed  Google Scholar 

  26. Kay SE, Doery J, Sholl D. Clozapine associated pericarditis and elevated troponin I. Aust N Z J Psychiatry. 2002;36:143–4. https://doi.org/10.1046/j.1440-1614.2002.0988f.x.

    Article  PubMed  Google Scholar 

  27. Catalano G, Catalano MC, Frankel Wetter RL. Clozapine induced polyserositis. Clin Neuropharmacol. 1997;20:352–6.

    Article  CAS  Google Scholar 

  28. Longhi S, Heres S. Clozapine-induced, dilated cardiomyopathy: a case report. BMC Res Notes. 2017;10:338. https://doi.org/10.1186/s13104-017-2679-5.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Alawami M, Wasywich C, Cicovic A, Kenedi C. A systematic review of clozapine induced cardiomyopathy. Int J Cardiol. 2014;176:315–20. https://doi.org/10.1016/j.ijcard.2014.07.103.

    Article  PubMed  Google Scholar 

  30. Kirpekar VC, Deshpande SM, Joshi PP. Reversible myocarditis in a patient receiving clozapine. Indian Heart J. n.d.;53:779–81.

    Google Scholar 

  31. Makhoul B, Hochberg I, Rispler S, Azzam ZS. Dilated cardiomyopathy: an unusual complication of clozapine therapy. Nat Clin Pract Cardiovasc Med. 2008;5:566–70. https://doi.org/10.1038/ncpcardio1292.

    Article  CAS  PubMed  Google Scholar 

  32. Cohen H, Loewenthal U, Matar MA, Kotler M. Reversal of pathologic cardiac parameters after transition from clozapine to olanzapine treatment: a case report. Clin Neuropharmacol. 2001;24:106–8. https://doi.org/10.1097/00002826-200103000-00008.

    Article  CAS  PubMed  Google Scholar 

  33. Walker AM, Lanza LL, Arellano F, Rothman KJ. Mortality in current and former users of clozapine. Epidemiology. 1997;8:671–7.

    Article  CAS  Google Scholar 

  34. Belhani D, Frassati D, Mégard R, Tsibiribi P, Bui-Xuan B, Tabib A, et al. Cardiac lesions induced by neuroleptic drugs in the rabbit. Exp Toxicol Pathol. 2006;57:207–12. https://doi.org/10.1016/j.etp.2005.09.003.

    Article  CAS  PubMed  Google Scholar 

  35. Warner JP, Barnes TR, Henry JA. Electrocardiographic changes in patients receiving neuroleptic medication. Acta Psychiatr Scand. 1996; 93:311–3.

    Article  CAS  Google Scholar 

  36. Reilly JG, Ayis SA, Ferrier IN, Jones SJ, Thomas SH. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet. 2000;355: 1048–52.

    Article  CAS  Google Scholar 

  37. Miura N, Saito T, Taira T, Umebachi R, Inokuchi S. Risk factors for QT prolongation associated with acute psychotropic drug overdose. Am J Emerg Med. 2015;33:142–9. https://doi.org/10.1016/j.ajem.2014.09.048.

    Article  PubMed  Google Scholar 

  38. Kang UG, Kwon JS, Ahn YM, Chung SJ, Ha JH, Koo YJ, et al. Electrocardiographic abnormalities in patients treated with clozapine. J Clin Psychiatry. 2000;61:441–6.

    Article  CAS  Google Scholar 

  39. Beach SR, Celano CM, Sugrue AM, Adams C, Ackerman MJ, Noseworthy PA, et al. QT prolongation, torsades de pointes, and psychotropic medications: a 5-year update. Psychosomatics. 2018;59: 105–22. https://doi.org/10.1016/j.psym.2017.10.009.

    Article  PubMed  Google Scholar 

  40. Carrà G, Crocamo C, Bartoli F, Lax A, Tremolada M, Lucii C, et al. First-generation antipsychotics and QTc: any role for mediating variables? Hum Psychopharmacol. 2016;31:313–8. https://doi.org/10.1002/hup.2540.

    Article  PubMed  Google Scholar 

  41. Glassman AH. Schizophrenia, antipsychotic drugs, and cardiovascular disease. J Clin Psychiatry. 2005; 66(Suppl 6):5–10.

    PubMed  Google Scholar 

  42. Aronow WS, Shamliyan TA. Effects of atypical antipsychotic drugs on QT interval in patients with mental disorders. Ann Transl Med. 2018;6:147. https://doi.org/10.21037/atm.2018.03.17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Leonard CE, Freeman CP, Newcomb CW, Bilker WB, Kimmel SE, Strom BL, et al. Antipsychotics and the risks of sudden cardiac death and all-cause death: cohort studies in Medicaid and dually-eligible Medicaid-Medicare beneficiaries of five states. J Clin Exp Cardiolog. 2013;Suppl 10: 1–9. https://doi.org/10.4172/2155-9880.S10-006.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Nosè M, Bighelli I, Castellazzi M, Martinotti G, Carrà G, Lucii C, et al. Prevalence and correlates of QTc prolongation in Italian psychiatric care: cross-sectional multicentre study. Epidemiol Psychiatr Sci. 2016;25:532–40. https://doi.org/10.1017/S2045796015000906.

    Article  PubMed  Google Scholar 

  45. Novotny T, Florianova A, Ceskova E, Weislamplova M, Palensky V, Tomanova J, et al. Monitoring of QT interval in patients treated with psychotropic drugs. Int J Cardiol. 2007;117:329–32. https://doi.org/10.1016/j.ijcard.2006.04.087.

    Article  PubMed  Google Scholar 

  46. Milnes JT, Witchel HJ, Leaney JL, Leishman DJ, Hancox JC. hERG K+ channel blockade by the antipsychotic drug thioridazine: an obligatory role for the S6 helix residue F656. Biochem Biophys Res Commun. 2006;351:273–80. https://doi.org/10.1016/j.bbrc.2006.10.039.

    Article  CAS  PubMed  Google Scholar 

  47. Schulz S, Bolz M, Bär K-J, Voss A. Central- and autonomic nervous system coupling in schizophrenia. Philos Trans R Soc A Math Phys Eng Sci. 2016; 374:20150178. https://doi.org/10.1098/rsta.2015.0178.

    Article  Google Scholar 

  48. Bär KJ, Letzsch A, Jochum T, Wagner G, Greiner W, Sauer H. Loss of efferent vagal activity in acute schizophrenia. J Psychiatr Res. 2005;39:519–27. https://doi.org/10.1016/j.jpsychires.2004.12.007.

    Article  PubMed  Google Scholar 

  49. Aguirre RR, Mustafa MZ, Dumenigo A, Schulz S, Voss A, Goubran B, et al. Influence of acute antipsychotic treatment on cardiorespiratory coupling and heart rate variability. Cureus. 2018;10:e2066. https://doi.org/10.7759/cureus.2066.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Iwamoto Y, Kawanishi C, Kishida I, Furuno T, Fujibayashi M, Ishii C, et al. Dose-dependent effect of antipsychotic drugs on autonomic nervous system activity in schizophrenia. BMC Psychiatry. 2012; 12:199. https://doi.org/10.1186/1471-244X-12-199.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Mueck-Weymann M, Rechlin T, Ehrengut F, Rauh R, Acker J, Dittmann RW, et al. Effects of olanzapine and clozapine upon pulse rate variability. Depress Anxiety. 2002;16:93–9. https://doi.org/10.1002/da.10037.

    Article  PubMed  Google Scholar 

  52. Pedrosa Gil F, Grohmann R, Rüther E. Asymptomatic bradycardia associated with amisulpride. Pharmacopsychiatry. 2001;34:259–61. https://doi.org/10.1055/s-2001-18033.

    Article  CAS  PubMed  Google Scholar 

  53. Hattori S, Kishida I, Suda A, Miyauchi M, Shiraishi Y, Fujibayashi M, et al. Effects of four atypical antipsychotics on autonomic nervous system activity in schizophrenia. Schizophr Res. 2018;193: 134–8. https://doi.org/10.1016/j.schres.2017.07.004.

    Article  PubMed  Google Scholar 

  54. Gugger JJ. Antipsychotic pharmacotherapy and orthostatic hypotension: identification and management. CNS Drugs. 2011;25:659–71. https://doi.org/10.2165/11591710-000000000-00000.

    Article  CAS  PubMed  Google Scholar 

  55. Leung JYT, Barr AM, Procyshyn RM, Honer WG, Pang CCY. Cardiovascular side-effects of antipsychotic drugs: the role of the autonomic nervous system. Pharmacol Ther. 2012;135:113–22. https://doi.org/10.1016/j.pharmthera.2012.04.003.

    Article  CAS  PubMed  Google Scholar 

  56. Petersen EN. Pre- and postsynaptic alpha-adrenoceptor antagonism by neuroleptics in vivo. Eur J Pharmacol. 1981;69:399–405.

    Article  CAS  Google Scholar 

  57. Cuffí ML, Vila E, Badia A. Effects of some antipsychotic drugs on cardiovascular catecholamine receptors in the rat. J Auton Pharmacol. 1989;9:397–409.

    Article  Google Scholar 

  58. Fda. Pharmacological Drugs Advisory Committee briefing document for Zyprexa intramuscular (olanzapine for injection). 2004.

    Google Scholar 

  59. Fda. Risperdal (risperidone). 2006.

    Google Scholar 

  60. Fda. Seroquel (quetiapine fumarate) tablets 2003; 2:1–31.

    Google Scholar 

  61. Fda. Clozaril (clozapine) tablets prescribing information. 2014.

    Google Scholar 

  62. Gonsai NH, Amin VH, Mendpara CG, Speth R, Hale GM. Effects of dopamine receptor antagonist antipsychotic therapy on blood pressure. J Clin Pharm Ther. 2018;43:1–7. https://doi.org/10.1111/jcpt.12649.

    Article  CAS  PubMed  Google Scholar 

  63. Henderson DC, Daley TB, Kunkel L, Rodrigues-Scott M, Koul P, Hayden D. Clozapine and hypertension: a chart review of 82 patients. J Clin Psychiatry. 2004;65:686–9.

    Article  CAS  Google Scholar 

  64. Woo YS, Kim W, Chae J-H, Yoon B-H, Bahk W-M. Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients. World J Biol Psychiatry. 2009;10:420–5. https://doi.org/10.1080/15622970801910399.

    Article  PubMed  Google Scholar 

  65. Correll CU, Joffe BI, Rosen LM, Sullivan TB, Joffe RT. Cardiovascular and cerebrovascular risk factors and events associated with second-generation antipsychotic compared to antidepressant use in a non-elderly adult sample: results from a claims-based inception cohort study. World Psychiatry. 2015;14:56–63. https://doi.org/10.1002/wps.20187.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Jönsson AK, Schill J, Olsson H, Spigset O, Hägg S. Venous thromboembolism during treatment with antipsychotics: a review of current evidence. CNS Drugs. 2018;32:47–64. https://doi.org/10.1007/s40263-018-0495-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Jönsson AK, Spigset O, Hägg S. Venous thromboembolism in recipients of antipsychotics. CNS Drugs. 2012;26:649–62. https://doi.org/10.2165/11633920-000000000-00000.

    Article  PubMed  Google Scholar 

  68. Wu CS, Lin CC, Chang CM, Wu KY, Liang HY, Huang YW, et al. Antipsychotic treatment and the occurrence of venous thromboembolism: a 10-year nationwide registry study. J Clin Psychiatry. 2013; 74:918–24. https://doi.org/10.4088/JCP.12m08117.

    Article  CAS  PubMed  Google Scholar 

  69. Letmaier M, Grohmann R, Kren C, Toto S, Bleich S, Engel R, et al. Venous thromboembolism during treatment with antipsychotics: results of a drug surveillance programme. World J Biol Psychiatry. 2018;19:175–86. https://doi.org/10.1080/15622975.2017.1285048.

    Article  PubMed  Google Scholar 

  70. Allenet B, Schmidlin S, Genty C, Bosson J-L. Antipsychotic drugs and risk of pulmonary embolism. Pharmacoepidemiol Drug Saf. 2012;21:42–8. https://doi.org/10.1002/pds.2210.

    Article  CAS  PubMed  Google Scholar 

  71. Franchi C, Sequi M, Tettamanti M, Bonometti F, Nobili A, Fortino I, et al. Antipsychotics prescription and cerebrovascular events in Italian older persons. J Clin Psychopharmacol. 2013;33:542–5. https://doi.org/10.1097/JCP.0b013e3182968fda.

    Article  CAS  PubMed  Google Scholar 

  72. Hsu W-T, Esmaily-Fard A, Lai C-C, Zala D, Lee S-H, Chang S-S, et al. Antipsychotics and the risk of cerebrovascular accident: a systematic review and meta-analysis of observational studies. J Am Med Dir Assoc. 2017;18:692–9. https://doi.org/10.1016/j.jamda.2017.02.020.

    Article  PubMed  Google Scholar 

  73. Chen W-Y, Chen L-Y, Liu H-C, Wu C-S, Yang S-Y, Pan C-H, et al. Antipsychotic medications and stroke in schizophrenia: a case-crossover study. PLoS One. 2017;12:e0179424. https://doi.org/10.1371/journal.pone.0179424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Wu CS, Wang SC, Gau SSF, Tsai HJ, Cheng YC. Association of stroke with the receptor-binding profiles of antipsychotics – a case-crossover study. Biol Psychiatry. 2013;73:414–21. https://doi.org/10.1016/j.biopsych.2012.07.006.

    Article  CAS  PubMed  Google Scholar 

  75. Wu C-S, Wu K-Y, Lo Y-R, Huang Y-W, Tsai Y-T, Li Y, et al. Psychotropic use and risk of stroke among patients with bipolar disorders: 10-year nationwide population based study. J Affect Disord. 2018;226: 77–84. https://doi.org/10.1016/j.jad.2017.09.020.

    Article  PubMed  Google Scholar 

  76. Ogłodek EA, Just MJ, Grzesińska AD, Araszkiewicz A, Szromek AR. The impact of antipsychotics as a risk factor for thromboembolism. Pharmacol Rep. 2018;70:533–9. https://doi.org/10.1016/j.pharep.2017.12.003.

    Article  CAS  PubMed  Google Scholar 

  77. Hare DL, Toukhsati SR, Johansson P, Jaarsma T. Depression and cardiovascular disease: a clinical review. Eur Heart J. 2014;35:1365–72. https://doi.org/10.1093/eurheartj/eht462.

    Article  PubMed  Google Scholar 

  78. Sauer WH, Berlin JA, Kimmel SE. Selective serotonin reuptake inhibitors and myocardial infarction. Circulation. 2001;104:1894–8.

    Article  CAS  Google Scholar 

  79. Moir DC, Crooks J, Sawyer P, Turnbull MJ, Weir RD. Proceedings: cardiotoxicity of tricyclic antidepressants. Br J Pharmacol. 1972;44:371P–2P.

    CAS  PubMed  PubMed Central  Google Scholar 

  80. Spindelegger CJ, Papageorgiou K, Grohmann R, Engel R, Greil W, Konstantinidis A, et al. Cardiovascular adverse reactions during antidepressant treatment: a drug surveillance report of German-speaking countries between 1993 and 2010. Int J Neuropsychopharmacol. 2014;18:1–9. https://doi.org/10.1093/ijnp/pyu080.

    Article  Google Scholar 

  81. Yap YG, Behr ER, Camm AJ. Drug-induced Brugada syndrome. Europace. 2009;11:989–94. https://doi.org/10.1093/europace/eup114.

    Article  PubMed  Google Scholar 

  82. Meert A, Vermeersch N, Beckers R, Hoste W, Brugada P, Hubloue I. Brugada-like ECG pattern induced by tricyclic antidepressants. Eur J Emerg Med. 2010;17:325–7. https://doi.org/10.1097/MEJ.0b013e328334a98f.

    Article  PubMed  Google Scholar 

  83. Brugada J, Campuzano O, Arbelo E, Sarquella-Brugada G, Brugada R. Present status of Brugada syndrome: JACC state-of-the-art review. J Am Coll Cardiol. 2018;72:1046–59. https://doi.org/10.1016/j.jacc.2018.06.037.

    Article  PubMed  Google Scholar 

  84. Minoura Y, Di Diego JM, Barajas-MartÍnez H, Zygmunt AC, Hu D, Sicouri S, et al. Ionic and cellular mechanisms underlying the development of acquired Brugada syndrome in patients treated with antidepressants. J Cardiovasc Electrophysiol. 2012;23:423–32. https://doi.org/10.1111/j.1540-8167.2011.02196.x.

    Article  PubMed  Google Scholar 

  85. Lusetti M, Licata M, Silingardi E, Reggiani Bonetti L, Palmiere C. Cardiac toxicity in selective serotonin reuptake inhibitor users. Am J Forensic Med Pathol. 2015;36:293–7. https://doi.org/10.1097/PAF.0000000000000205.

    Article  PubMed  Google Scholar 

  86. Lapane KL, Zierler S, Lasater TM, Barbour MM, Carleton R, Hume AL. Is the use of psychotropic drugs associated with increased risk of ischemic heart disease? Epidemiology. 1995;6:376–81.

    Article  CAS  Google Scholar 

  87. Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. Am J Med. 2000;108:2–8.

    Article  CAS  Google Scholar 

  88. Monster TBM, Johnsen SP, Olsen ML, McLaughlin JK, Sørensen HT. Antidepressants and risk of first-time hospitalization for myocardial infarction: a population-based case-control study. Am J Med. 2004;117:732–7. https://doi.org/10.1016/j.amjmed.2004.06.027.

    Article  CAS  PubMed  Google Scholar 

  89. Castro VM, Clements CC, Murphy SN, Gainer VS, Fava M, Weilburg JB, et al. QT interval and antidepressant use: a cross sectional study of electronic health records. BMJ. 2013;346:f288. https://doi.org/10.1136/bmj.f288.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. van Noord C, Straus SMJM, Sturkenboom MCJM, Hofman A, Aarnoudse A-JLHJ, Bagnardi V, et al. Psychotropic drugs associated with corrected QT interval prolongation. J Clin Psychopharmacol. 2009;29:9–15. https://doi.org/10.1097/JCP.0b013e318191c6a8.

    Article  CAS  PubMed  Google Scholar 

  91. Kahl KG, Westhoff-Bleck M, Krüger THC. Effects of psychopharmacological treatment with antidepressants on the vascular system. Vasc Pharmacol. 2017;96–98:11–8. https://doi.org/10.1016/j.vph.2017.07.004.

    Article  CAS  Google Scholar 

  92. Jackson WK, Roose SP, Glassman AH. Cardiovascular toxicity of antidepressant medications. Psychopathology. 1987;20:64–74. https://doi.org/10.1159/000284525.

    Article  PubMed  Google Scholar 

  93. Hanash JA, Hansen BH, Hansen JF, Nielsen OW, Rasmussen A, Birket-Smith M. Cardiovascular safety of one-year escitalopram therapy in clinically nondepressed patients with acute coronary syndrome. J Cardiovasc Pharmacol. 2012;60:397–405. https://doi.org/10.1097/FJC.0b013e3182677041.

    Article  CAS  PubMed  Google Scholar 

  94. Van de Merwe TJ, Silverstone T, Ankier SI. Electrophysiological and haemodynamic changes with trazodone, amitriptyline and placebo in depressed out-patients. Curr Med Res Opin. 1984; 9:339–52. https://doi.org/10.1185/03007998409109602.

    Article  PubMed  Google Scholar 

  95. Levenson JL. Prolonged QT interval after trazodone overdose. Am J Psychiatry. 1999;156:969–70. https://doi.org/10.1176/ajp.156.6.969a.

    Article  CAS  PubMed  Google Scholar 

  96. Rajamani S, Eckhardt LL, Valdivia CR, Klemens CA, Gillman BM, Anderson CL, et al. Drug-induced long QT syndrome: hERG K+ channel block and disruption of protein trafficking by fluoxetine and norfluoxetine. Br J Pharmacol. 2006;149:481–9. https://doi.org/10.1038/sj.bjp.0706892.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Bhangu JS, King-Kallimanis B, Cunningham C, Kenny RA. The relationship between syncope, depression and anti-depressant use in older adults. Age Ageing. 2014;43:502–9. https://doi.org/10.1093/ageing/afu003.

    Article  PubMed  Google Scholar 

  98. Briggs R, Carey D, McNicholas T, Claffey P, Nolan H, Kennelly SP, et al. The association between antidepressant use and orthostatic hypotension in older people: a matched cohort study. J Am Soc Hypertens. 2018. https://doi.org/10.1016/j.jash.2018.06.002.

  99. Mehta N, Vannozzi R. Lithium-induced electrocardiographic changes: a complete review. Clin Cardiol. 2017;40:1363–7. https://doi.org/10.1002/clc.22822.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Altinbas K, Guloksuz S, Caglar IM, Caglar FNT, Kurt E, Oral ET. Electrocardiography changes in bipolar patients during long-term lithium monotherapy. Gen Hosp Psychiatry. 2014;36:694–7. https://doi.org/10.1016/j.genhosppsych.2014.07.001.

    Article  PubMed  Google Scholar 

  101. Venkatarathnamma PN, Patil AR, Nanjundaiah N. Fatal lithium toxicity with therapeutic levels – a case report. Int J Clin Pharmacol Ther. 2011;49:336–8.

    Article  CAS  Google Scholar 

  102. Lyman GH, Williams CC, Dinwoodie WR, Schocken DD. Sudden death in cancer patients receiving lithium. J Clin Oncol. 1984;2:1270–6. https://doi.org/10.1200/JCO.1984.2.11.1270.

    Article  CAS  PubMed  Google Scholar 

  103. Ide A, Kamijo Y. Intermittent complete atrioventricular block after long term low-dose carbamazepine therapy with a serum concentration less than the therapeutic level. Intern Med. 2007;46:627–9.

    Article  Google Scholar 

  104. Koutsampasopoulos K, Zotos A, Papamichalis M, Papaioannou K. Carbamazepine induced atrial tachycardia with complete AV block. Hippokratia. 2014; 18:185–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  105. Kasarskis EJ, Kuo CS, Berger R, Nelson KR. Carbamazepine-induced cardiac dysfunction. Characterization of two distinct clinical syndromes. Arch Intern Med. 1992;152:186–91.

    Article  CAS  Google Scholar 

  106. Alabi A, Todd A, Husband A, Reilly J. Safety profile of lamotrigine in overdose. Ther Adv Psychopharmacol. 2016;6:369–81. https://doi.org/10.1177/2045125316656707.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  107. Barrett JS, Hey EB. Ventricular arrhythmias associated with the use of diazepam for cardioversion. JAMA. 1970;214:1323–4.

    Article  CAS  Google Scholar 

  108. Costa A, Bosone D, Zoppi A, D’Aposangelo A, Ghiotto N, Guaschino E, et al. Effect of diazepam on 24-hour blood pressure and heart rate in healthy young volunteers. Pharmacology. 2018;101:86–91. https://doi.org/10.1159/000481665.

    Article  PubMed  Google Scholar 

  109. Fogari R, Costa A, Zoppi A, D’Angelo A, Ghiotto N, Battaglia D, et al. Diazepam as an oral hypnotic increases nocturnal blood pressure in the elderly. Aging Clin Exp Res. 2018. https://doi.org/10.1007/s40520-018-0991-0.

  110. Jick H. Drugs – remarkably nontoxic. N Engl J Med. 1974;291:824–8. https://doi.org/10.1056/NEJM197410172911605.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy

    Anna Maria Pugliese, Elisabetta Coppi, Federica Cherchi & Giancarlo Pepeu

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  1. Anna Maria Pugliese
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  2. Elisabetta Coppi
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  3. Federica Cherchi
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  4. Giancarlo Pepeu
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Correspondence to Anna Maria Pugliese .

Editor information

Editors and Affiliations

  1. Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy

    Stefano Govoni

  2. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Pierluigi Politi

  3. Department of Molecular Medicine, University of Pavia, Pavia, Italy

    Emilio Vanoli

Section Editor information

  1. Dipartimento NeuroFarBa (Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino), Università degli Studi di Firenze, Firenze, Italy

    Raffaele Coppini

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Pugliese, A.M., Coppi, E., Cherchi, F., Pepeu, G. (2020). Cardiovascular Adverse Effects of Psychotropic Drugs. In: Govoni, S., Politi, P., Vanoli, E. (eds) Brain and Heart Dynamics. Springer, Cham. https://doi.org/10.1007/978-3-030-28008-6_45

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