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The Cardiovascular Effects of Newer Antidepressants in Older Adults and Those With or At High Risk for Cardiovascular Diseases

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Abstract

Depression is common in older adults and those with cardiovascular disease. Although selective serotonin reuptake inhibitors generally have been shown to be safe to treat depression in these patients, it is important to identify additional antidepressants when selective serotonin reuptake inhibitors are not effective. This qualitative narrative review summarizes what is known about the cardiovascular side effects of some of the newer antidepressants. Twelve novel non-selective serotonin reuptake inhibitor antidepressants were identified from the literature: venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran, mirtazapine, bupropion, vilazodone, vortioxetine, agomelatine, moclobemide, and ketamine–esketamine. A search restricted to publications written in English was conducted in PubMed and Google Scholar with the following search criteria: the specific antidepressant AND (QT OR QTc OR “heart rate” OR “heart rate variability” OR “hypertension” OR “orthostatic hypotension” OR “cardiovascular outcomes” OR “arrhythmia” OR “myocardial infarction” OR “cardiovascular mortality”) AND (geriatric OR “older adults” OR “late life depression” OR “cardiovascular disease” OR “hospitalized” OR “hospitalized”). The recommended use, dosing ranges, cardiovascular effects, and general advantages and disadvantages of each of the drugs are discussed. Levomilnacipran and vilazodone have not received enough study to judge their safety in older patients or in those with, or at high risk for, cardiovascular disease. There is at least some evidence for possible adverse events with each of the other newer antidepressants that could be of concern in these patients. Nevertheless, with careful administration and attention to the potential adverse reactions for each drug, these may provide safe effective alternatives for older adults and patients with cardiovascular disease who do not respond to selective serotonin reuptake inhibitor antidepressants. However, more research on the safety and efficacy of these drugs in these specific patient populations is urgently needed.

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Authors and Affiliations

  1. Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, Saint Louis, MO, 63108, USA

    Lauren M. Behlke, Eric J. Lenze & Robert M. Carney

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  1. Lauren M. Behlke
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  2. Eric J. Lenze
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  3. Robert M. Carney
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Correspondence to Robert M. Carney.

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Funding

Preparation of this manuscript was supported in part by Grant number R01HL089336 from the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD, USA, Robert M. Carney, Principal Investigator, The Taylor Family Institute for Innovative Psychiatric Treatments, and the Center for Brain Research in Mood Disorders at Washington University.

Conflict of Interest

Lauren Behlke has no conflicts of interest that are directly relevant to the content of this article. Eric Lenze has received research grants from Takeda, Janssen, Lundbeck, Acadia, PCORI, Barnes Jewish Hospital, McKnight Brain Research Foundation, and Aptinyx, and consulting fees from Janssen and Jazz Pharmaceuticals. Robert M. Carney or a member of his family owns stock in Pfizer, Incorporated.

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Behlke, L.M., Lenze, E.J. & Carney, R.M. The Cardiovascular Effects of Newer Antidepressants in Older Adults and Those With or At High Risk for Cardiovascular Diseases. CNS Drugs 34, 1133–1147 (2020). https://doi.org/10.1007/s40263-020-00763-z

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