Antidepressant drugs cardiovascular disease

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that stimulates the pineal gland s ability to produce melatonin. Antipsychotic drugs also have this effect. Other medicines have the opposite effect. Certain types of medicines used to treat cardiovascular disease called beta blockers reduce the production of melatonin by the pineal gland. Nonsteroidal antiinflammatories, which are used to treat pain and/or fever,... 

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39% in those of 40 years. Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14%). While the evidence is not conclusive, drug therapy is thought to underlie 25% of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H -receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly adrenoceptor blockers and thiazide diuretics. 

Americans (26). It is involved in the metabolism of approximately 30-40 commonly used drugs. Millions of patients with compromised metabolism are thus at risk of adverse drug reactions when prescribed drugs that are CYP2D6 substrates. Many such drugs are used for treating psychiatric (such as antidepressants and antipsychotics) and cardiovascular diseases (such as j8-blockers and antiar-rhythmics), where the therapeutic window can be narrow and side effects common. 

Similar caution should be exercised with biogenic amine uptake blockers such as tricyclic antidepressants. Amphetamine is contraindicated in advanced arteriosclerosis symptomatic cardiovascular disease moderate to severe hypertension hyperthyroidism hypersensitivity or idiosyncrasy to the sympathomimetic amines glaucoma agitated states history of drug abuse and during or within 14 days following administration of monoamine oxidase (MAO) inhibitors. 

Epinephrine usually Is administered slowly by Intravenous (IV) Injection to relieve acute asthmatic attacks not controlled by other treatments. Intravenous Injection produces an Immediate response. Use of EPI with drugs that enhance cardiac arrhythmias (digitalis or quinidine) Is not recommended. Tricyclic antidepressants and MAO Inhibitors will potentiate the effects of EPI on the heart. Epinephrine should be used with caution In Individuals suffering from hyperthyroidism, cardiovascular disease, hypertension, or diabetes. Adverse effects Include palpitations, tachycardia, sweating, nausea and vomiting, respiratory difficulty, dizziness, tremor, apprehension, and anxiety. 

Sudden death has occurred in patients with preexisting heart disease on antidepressant therapy. It may be difficult, however, to separate a causally related drug effect from a cardiovascular incident precipitated by other factors and only by chance coincident with drug therapy. Furthermore, Roose ( 418), who has summarized the literature, noted that major depressive disorder occurs frequently after a myocardial infarct and may adversely affect the recovery process. 

Benzodiazepines are often bioactive compounds, widely used as anticonvulsants, antianxiety, hypnotic agents, analgesics, antidepressives, and anti-inflammatory drugs (Figure 19) [159]. For instance, 1,5-benzodiazepines are useful precursors for the synthesis of some benzodiazepine derivatives with pharmacological properties, such as tri-axolo-, triazolo-, oxadiazolo-, oxazino-, or furano-benzodiazepines. In particular, the application of these compoxmds has been also extended to various diseases, such as cancer, viral infection, and cardiovascular disorders. 

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