Cardiac Effects of Psychotropic Drugs: An Overview

Introduction:

The most prevalent side effects of cardiac psychotropic drugs are arrhythmias (irregular heartbeat) and orthostatic hypotension (low blood pressure that occurs due to standing). The most prevalent and controllable side effects include benign arrhythmias and orthostatic hypotension. The risk of cardiovascular side effects is higher for antipsychotics such as Clozapine. Thus, they require special consideration. Dysrhythmias, especially QT interval lengthening, are common with tricyclic antidepressants and lithium. Although there is little risk of myocardial infarction during antidepressant therapy, the risk of cardiovascular side effects with non-tricyclic antidepressants is low or nonexistent for mood modifiers, except lithium and anxiolytics.

What Are the Cardiac Effects of Psychotropic Drugs?

The World Health Organization defines an adverse drug reaction as an unpleasant response to a drug that occurs at levels commonly employed for disease prevention, diagnosis, or therapy or for the alteration of physiological function. Certain antidepressants and antipsychotic medicines have significant cardiovascular adverse effects that can lead to cardiovascular issues, including ventricular arrhythmias, which have resulted in the death of patients with no prior cardiac history.

Furthermore, psychiatric medicines have a variety of circulatory effects that may have a deleterious impact on cardiac patients' clinical outcomes. Based on these reasons, a new class of antidepressants with fewer cardiovascular adverse effects has been developed. Selective serotonin reuptake medications (SSRIs) are promising, effective, and tolerable medication that has the potential to improve the quality of life for patients with acute coronary syndromes and their families.

What Are the Common Cardiac Adverse Reactions to Psychotropic Drugs?

Antipsychotic medicines are prescribed to treat psychotic symptoms as well as other mental and emotional disorders. The first class of these medications is known as typical antipsychotics. The second class is known as atypical antipsychotics. The most common adverse reactions reported during psychotropic drug treatment are as follows:

• Arrhythmias (Irregular Heartbeat) - This occurs because antidepressants and neuroleptics affect several ion channels involved in the control of cardiac action potentials and thus exert proarrhythmic activity. Arrhythmias, particularly torsades de pointes and ventricular function deficit, can result in sudden death.

• Orthostatic Hypotension - Antipsychotic-induced orthostatic alterations, together with age-related loss of postural reflexes, enhance the risk of falls in older persons. As a result, orthostatic hypotension episodes are especially harmful at night, when the elderly patient awakens to urinate and immediately jumps out of bed.

• Tachycardia (Increased Heart Rate) - It is another negative health effect associated with antipsychotic medicines, which appears to be caused mostly by antipsychotics, and they also increase the risk of sudden cardiac death. The QT interval on the electrocardiogram is a surrogate marker for the risk of developing a kind of ventricular tachyarrhythmia known as torsades de pointes (TdP), which can be seen as a twisting of the QRS axis. TdP causes fatigue, fainting, and cardiac arrhythmic death due to ventricular fibrillation. Some antipsychotics like Ziprasidone, in particular, can exacerbate a potentially fatal cardiac arrhythmia. In addition to their effect on cardiac conduction, antipsychotic medications have few side effects in the event of an overdose:

  • Clozapine causes tachycardia.
  • Olanzapine and Quetiapine do not cause sudden death but cause tachycardia.
  • Risperidone causes no significant symptoms in 66 percent of cases but may cause sudden death.

What Are the Risk Factors for Psychotropic Drugs That Lead to Death?

• Reduced heart rate variability is one of the leading factors to increase the risk of cardiac death in patients with myocardial infarction and cardiac failure. This lowered heart rate variability may be related to the anticholinergic effects of psychiatric medicines.

• According to ten-year cohort research, it was found that the relative risk of death in schizophrenics was cardiovascular disease.

• Polymedication has also been found as a separate risk factor for death.

• Thioridazine, a long-used and extensively prescribed neuroleptic medicine, has also been known to cause cardiac adverse effects and death.

What Are the Advantages of Serotonin Reuptake Inhibitors (SSRIs) Over Tricyclic Antidepressants (TCAs)?

Serotonin reuptake inhibitors (SSRIs) have essentially replaced tricyclic antidepressants (TCAs) as the drug of choice in the treatment of mental disorders. The main distinction between SSRIs and TCAs is that SSRIs have a considerable amount of mild cardiotoxicity. Indeed, SSRIs are now more commonly prescribed than TCAs due to their lower side effect profiles and lower toxicity following overdose. So far, only two SSRI overdose deaths have been documented in the literature, one involving the consumption of Fluoxetine and the other involving the ingestion of Citalopram. SSRIs cause far fewer cardiotoxic adverse effects than TCAs, such as mild bradycardia (decreased heart rate), orthostatic hypotension, and abnormalities in the electrical activity of the heart.

Serotonin buildup in platelets is inhibited by SSRIs but not TCA medications, and it normalizes increased indices of platelet activation and aggregation in patients with depression and ischemic (lack of oxygen) heart disease. SSRIs also have a considerably lower rate of myocardial infarction than non-SSRI individuals. Thus, the use of TCAs and structurally related antidepressants in cardiac patients should be limited due to the plethora of negative effects on the cardiovascular system, including orthostatic hypotension, tachycardia, and decreased heart rate variability. These antidepressants should never be given to anyone who has a bundle branch block. Treatments with SSRIs may offer considerable advantages in depressed or anxious individuals with cardiovascular disease due to their fewer possible adverse effects on the cardiovascular system and the lack of mortality from an overdose.

Conclusion:

The cardiac side effects of psychiatric medicines are a cost that a patient must pay in order to benefit from therapeutic benefits. As a result, the physician must exercise extreme caution while providing medicines, and it is vital to monitor for unpleasant reactions in order to guarantee that patients receive therapeutic benefits. If the risk of unpleasant and unexpected drug reactions is so significant, patients should proceed with caution when obtaining drugs. Individuals with a history of cardiovascular disease, on the other hand, should be thoroughly checked before starting any antipsychotic medication. Anticholinergic drugs, or those that produce orthostatic hypotension, in particular, should be used with extreme caution. The physician's discretion is always required, and focus should be placed on recognizing probable bad reactions in order to implement preventative strategies that may help reduce the risk of adverse medication reactions.