Recent Heart Attack or Stroke? Zoloft Is Safest Antidepressant

A recent study (the Smoller study) showed that antidepressants may increase your risk of stroke and/or death. According to the study, selective serotonin reuptake inhibitors (SSRI) increase the risk of all-cause death by 40%; tricyclic antidepressants (TCA) increase the risk by 30%. In theory SSRI antidepressants (like Paxil and Prozac) can cause brain bleeds (i.e. bleeding strokes) by making your blood less sticky. TCA antidepressants (like Elavil and Aventyl), Effexor, Cymbalta and Pristiq are known to cause unusual heartbeats in at-risk people.

Despite their negative effects on the heart and on blood stickiness, several studies contradict the findings of the Smoller study. In fact, some studies suggest that the SSRIs’ ability to make blood less sticky may prevent blood clots (and, consequently, protect against heart attack).

As of today, only two antidepressants have been studied well in patients who have a high risk for heart attack and/or stroke: Zoloft and Lexapro. A summary of the Zoloft study (the SADHEART study) is presented below…

To determine the safety and effect of sertraline (Zoloft) treatment of depression in patients hospitalized for heart attack

A four year study conducted in the United States, Europe, Canada, and Australia.

369 patients with depression (64% male; mean age, 57.1 years)

Patients were assigned to receive sertraline (Zoloft) in flexible dosages of 50 to 200 mg/day or a placebo for 24 weeks.

Sertraline (Zoloft) did increase risk for heart failure, heart arrythmia or cardiovascular disease. Patients who took sertraline (Zoloft) were scored better on the HAD-D depression scale than patients who did not take the drug.

Sertraline (Zoloft) is a safe and effective treatment for recurrent depression in patients with recent heart attack.

Bottom Line
If you have had a heart attack recently, and are depressed, Zoloft (or Lexapro) are likely the safest antidepressants. Avoid TCA antidepressants (Elavil or Aventyl); they can cause arrythmias and low blood pressure. Effexor, Cymbalta and Pristiq may be unsafe options, too.

Recommended Reading

  1. Glassman AH, O’Connor CM, Califf RM, et al. Sertraline Antidepressant Heart Attack Randomized Trial (SADHEART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002;288:701-9
  2. Smoller JW, Allison M, Cochrane BB, et al. Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women’s Health Initiative study. Arch Intern Med 2009;169:2128-39

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