RISCO DE MORTE SÚBITA CARDÍACA E EFEITOS ADVERSOS CARDIOVASCULARES ASSOCIADOS AO USO DE ANTIDEPRESSIVOS

Abstract

Introduction: Treatment of depression / depressive disorder requires effective therapeutic agents, well tolerated and with a low rate of complications and adverse events. However, some antidepressants(AD)have been associated with an increased risk of sudden cardiac death (SCD) and general and cardiovascular adverse events, important in daily clinical practice. Objective: Raise possible adverse cardiovascular events and risk of SCD associated with AD use in adult patients. Additionally, investigate general adverse effects, action mechanisms and main risk drug interactions with AD and guidelines for monitoring / optimized clinical management of patients. Methodology: integrative review aiming, from scientific literature, to collect information regarding the objectives of this review in the main databases: PubMed; Lilacs; Google Scholar; Brazilian´s Health Ministry. Selection criteria were: meta-analysis articles, systematic review, review, guidelines, consensus and observational studies (cohort studies, case-control or cross-sectional studies) and randomized control studies, published between 2010 and April 2023. Results: 173 publications were selected allowing verify which patients had high risk for developing adverse cardiovascular events associated with the use of AD: elderly; preexisting cardiovascular risk factors; patients with comorbidities (mainly acute and/or chronic coronary artery disease, heart failure and renal failure); CYP450 poor/slow metabolizers; previous history of ventricular arrhythmias or syncope; carriers of channelopathies; family history of long QT syndrome, sudden death, diabetes mellitus and arterial hypertension; polypharmacy; AD use in high doses; electrolyte abnormalities (eg: hypokalemia, hypomagnesaemia, etc.). Studies demonstrated that selective serotonin reuptake inhibitors had a relative risk of SCD of 2.39 (95%CI 1.20-4.80) while tricyclic ADs risk ranging from 1.69 (95%CI 1.14-2.50) at 4.37 (95%CI 1.23-15.60). We summarized the risk information in tables and charts with recommendations from main studies and guidelines regarding the clinical management, monitoring and management of adverse events. Conclusion: Although the use of ADs has recognized general and cardiovascular adverse effects, their risks shouldn´t deprive patients of appropriate therapy for psychiatric disorders, including those with cardiovascular diseases. The available literature data allow adopting screening of patients who need the use of DA, monitoring treatment and adopting effective preventive measures to reduce the risk of possible complications.