The treatment of psychiatric disorders in patients with cardiovascular disease

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.