Glassman A H
Department of Clinical Psychopharmacology, New York State Psychiatric Institute, College of Physicians & Surgeons of Columbia University, New York 10032, USA.
J Clin Psychiatry. 1998;59 Suppl 15:13-8.
The cardiovascular effects of tricyclic antidepressants (TCAs), including the propensity of these agents to be fatal in overdose, have been well described. It has been established further that even at therapeutic doses the TCAs may have untoward cardiovascular effects in the context of underlying ischemic heart disease. By comparison, the selective serotonin reuptake inhibitors (SSRIs) as a class are less likely to affect cardiovascular parameters in depressed patients who are otherwise healthy. Importantly, the SSRIs in overdose situations are enormously safer than TCAs and rarely have been associated with cardiotoxic effects when ingested alone. More recently, the safety and efficacy of several of the SSRIs have been evaluated in patients with existing ischemic heart disease. Although the studies have involved a limited number of patients, the available data suggest that SSRIs are not associated with adverse cardiovascular effects in these patients and are safer than TCAs in the treatment of depression in patients with heart disease. The prevalence of cardiovascular disease and the evidence that comorbid depression with cardiovascular disease (for example, following myocardial infarction) increases the risk of mortality underscore the importance of understanding the cardiac effects of antidepressants and the need for effective antidepressants that are free of adverse cardiovascular effects. At present, the SSRIs should be considered first-line agents for the treatment of depressed patients with cardiovascular illness, particularly ischemic heart disease. Among the SSRIs, those with a lower potential for causing pharmacokinetic drug interactions generally are preferred.
三环类抗抑郁药（TCAs）的心血管效应，包括这些药物在过量服用时的致命倾向，已有详尽描述。进一步证实，即便在治疗剂量下，TCAs在存在潜在缺血性心脏病的情况下也可能产生不良心血管效应。相比之下，作为一类药物，选择性5-羟色胺再摄取抑制剂（SSRIs）在其他方面健康的抑郁症患者中影响心血管参数的可能性较小。重要的是，SSRIs在过量服用情况下比TCAs安全得多，单独服用时很少与心脏毒性作用相关。最近，已对几种SSRIs在现有缺血性心脏病患者中的安全性和疗效进行了评估。尽管这些研究涉及的患者数量有限，但现有数据表明，SSRIs在这些患者中不会产生不良心血管效应，且在治疗心脏病患者的抑郁症方面比TCAs更安全。心血管疾病的患病率以及心血管疾病合并抑郁症（如心肌梗死后）会增加死亡风险的证据，凸显了了解抗抑郁药心脏效应的重要性以及对无不良心血管效应的有效抗抑郁药的需求。目前，SSRIs应被视为治疗患有心血管疾病尤其是缺血性心脏病的抑郁症患者的一线药物。在SSRIs中，引起药代动力学药物相互作用可能性较低的药物通常更受青睐。
