Antidepressant Use Among People With Heart Disease

Proper Treatment of Depression Is Key to Health

In people with heart disease, depression is more likely to lead to heart attack, stroke and chest pain than is smoking, high blood pressure or even diabetes. But the odds can be evened by taking antidepressants known as selective serotonin reuptake inhibitors (SSRIs), according to a Canadian study published in the 2007 Journal of the American Medical Association.

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Patients who suffer depression--around 50% of those hospitalized and as many as one-fifth of others--are up to five times more likely to die or experience further heart problems within the next year than others.

SSRIs, such as Celexa (citalopram), Prozac (fluoxetine) and Zoloft (sertraline), are thought to improve mood by preventing nerve cells from reabsorbing serotonin, thus increasing the amount of the neurotransmitter in the brain. Having low levels of serotonin is associated with depression, so "reuptake inhibitors," by keeping more serotonin available to the brain, may relieve depression. These medications are safe for heart patients and work well for many.

According to the Journal study, SSRIs are more effective than interpersonal psychotherapy in improving depression in heart patients.

During the first few weeks of taking an SSRI, patients may actually experience increased anxiety until the drug is fully effective -- usually in 4 to 6 weeks. Adverse effects that may last throughout the time the medication is taken include sexual difficulties, nausea, and headache.

Some SSRIs, when paired with the antibiotic erythromycin, can increase the risk of irregular heartbeat or sudden death. Make sure the physician who prescribes your antidepressant has a full list of any other medications you are taking.

How Depression Affects the Cardiovascular System

Controlling depression is critical for heart patients because, unchecked, it can keep the body in a chronic state of emergency preparedness, which has several serious implications:

  • Increased hormone levels
  • Constricted blood vessels
  • Elevated heart rate

Eventually, this constant state of readiness damages blood vessels and desensitizes the heart to indicators that tell it to slow down.

When people with heart conditions receive treatment for depression, this treatment helps decrease their perception of pain, enhances energy, improves socialization and increases their likelihood of quitting smoking, limiting alcohol consumption, exercising and eating right.

Some Harmful Antidepressants

Several antidepressants other than SSRIs can actually be dangerous for those with heart disease:

Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs), including Effexor (venlafaxine), may increase blood pressure.

Tricyclics, such as Elavil (amitriptyline), may cause dizziness and elevated heart rate.

Monoamine Oxidase Inhibitors (MAOIs), which include Nardil (phenelzine), can cause irregular heartbeat and sharply elevated blood pressure when paired with certain foods.

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  • "Antidepressants." 2007. The Royal College of Psychiatrists.
  • "Effects of Citalopram and Interpersonal Psychotherapy on Depression in Patients With Coronary Artery Disease." Journal of the American Medical Association 297:4(2007):367-379. 
  • "Erythromycin and Risk of Sudden Cardiac Death." 2008. American Heart Organization.
  • "Harvard Mental Health Letter: Mind and Mood After a Heart Attack ." Feb. 1 2006. Harvard Medical School. 
  • "Medications." 26 June 2008. National Institutes of Health. 
  • "SSRI Research." 2008. National Institutes of Health.