TCAs should be avoided after major cardiovascular events

Antidepressants are amongst the very widely prescribed medications in many nations. Researchers have recently studied the association of antidepressants with major adverse cardiovascular events (including death). In a historical study of 1266 patients who completed cardiac rehabilitation in a major center. 433 (34.2%) participants were treated with antidepressants, with the largest proportion of these receiving SSRIs (n = 299; 23.6%). Discontinuation rates ranged from 37.3% for TCAs to 53.2% for SNRIs. After a median follow-up of 4.7 years, 264 (20.9%) participants had a major adverse cardiac event. Those taking tricyclics had significantly more of these events than those not taking TCAs (HR = 2.46; 95% CI 1.37–4.42), and those on SSRI (HR = 1.45; 95% CI 1.07–1.97). The use of all antidepressants except SNRIs was associated with more adverse cardiac events.