Clinical use of antidepressant therapy and associated cardiovascular risk.
Clinical use of antidepressant therapy and associated cardiovascular risk.
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DOI：
10.2147/dhps.s28804
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Waring WS
中科院分区：
文献类型：
--
作者：
Waring WS
许多不同的精神药物与心血管疾病风险增加相关，由于存在混杂因素，这些关系难以解释。最近，人们重新关注某些抗抑郁药引起QT间期延长的可能性，QT间期延长是心律失常的诱发因素。然而，由于在临床环境中容易应用的方法与监管评估期间更详细的技术之间的差异，确定QT的最佳方法仍然存在争议。许多不同的药理学机制可以解释不良心脏效应的发生，并且这些机制根据抗抑郁药的类型而不同。新出现的数据表明，西酞普兰对QT间期延长表现出剂量-效应关系。尽管在故意抗抑郁药过量的情况下，心脏毒性很明显，但治疗性给药导致的心脏效应的发生不太确定。既存心脏病和其他独立诱发心律失常的因素是重要的考虑因素。因此，需要临床判断来评估特定抗抑郁药在任何患者中的总体风险或获益。对于QT间期延长和心律失常风险最大的患者，应考虑进行密切监测。
A number of different psychotropic agents have been associated with an increased risk of cardiovascular disease, and these relationships have been difficult to interpret due to the presence of confounding factors. Recently, there has been renewed interest in the potential for certain antidepressants to cause QT prolongation, which is a predisposing factor for arrhythmia. However, the optimum means of determining QT remains contentious due to discrepancies between methods that may be readily applied in a clinical setting versus more detailed techniques during regulatory assessment. A number of different pharmacological mechanisms might explain the occurrence of adverse cardiac effects, and these differ according to the type of antidepressant agent. Emerging data indicate that citalopram exhibits a dose-effect relationship for QT prolongation. Whereas cardiotoxicity is readily apparent in the context of intentional antidepressant overdose, the occurrence of cardiac effects as a result of therapeutic administration is less certain. Pre-existing cardiac disease and other factors that independently predispose to arrhythmia are important considerations. Therefore, clinical judgment is needed to evaluate the overall risk or benefit of a particular antidepressant in any patient. Close monitoring should be considered for those at greatest risk of QT prolongation and arrhythmia.