The Cardiovascular Effects of Newer Antidepressants in Older Adults and Those With or At High Risk for Cardiovascular Diseases.
The Cardiovascular Effects of Newer Antidepressants in Older Adults and Those With or At High Risk for Cardiovascular Diseases.
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DOI：
10.1007/s40263-020-00763-z
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发表时间：
2020-11
期刊：
影响因子：
6
通讯作者：
Carney RM
中科院分区：
文献类型：
--
作者：
Behlke LM;Lenze EJ;Carney RM
抑郁症在老年人和心血管疾病患者中很常见。虽然5-羟色胺再摄取抑制剂（SSRIs）通常已被证明是安全的，以治疗这些患者的抑郁症，重要的是要确定额外的抗抑郁药时，SSRIs是无效的。这篇定性的叙述性综述总结了一些较新的抗抑郁药的心血管副作用。从文献中确定了12种新型非SSRI抗抑郁药：文拉法辛、去甲文拉法辛、度洛沙汀、米那普仑、左米那普仑、米氮平、安非他酮、维拉唑酮、沃替西汀、阿戈美拉汀、吗氯贝胺和氯胺酮-艾司氯胺酮。使用以下检索标准在PubMed和Google Scholar中进行了仅限于英文出版物的检索：具体的抗抑郁药和（QT或QTc或“心率”或“心率变异性”或“高血压”或“直立性低血压”或“心血管结局”或“心律失常”或“心肌梗死”或“心血管死亡率”）和（老年或“老年人”或“晚年抑郁症”或“心血管疾病”或“住院”或“住院”）。每种药物的推荐使用，剂量范围，心血管效应和一般的优点和缺点进行了讨论。左旋米那普仑和维拉唑酮还没有得到足够的研究来判断它们在老年患者或患有心血管疾病或高风险患者中的安全性。至少有一些证据表明，其他每种新的抗抑郁药可能会引起这些患者的关注。尽管如此，通过仔细管理和注意每种药物的潜在不良反应，这些药物可能为老年人和对SSRI抗抑郁药无反应的心血管疾病患者提供安全，有效的替代品。然而，迫切需要对这些药物在这些特定患者人群中的安全性和有效性进行更多研究。
Depression is common in older adults and those with cardiovascular disease. Although serotonin reuptake inhibitors (SSRIs) generally have been shown to be safe to treat depression in these patients, it is important to identify additional antidepressants when SSRIs 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-SSRI 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 SSRI antidepressants. However, more research on the safety and efficacy of these drugs in these specific patient populations is urgently needed.
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