Cardiovascular Adverse Effects of Psychotropic Drugs

The cardiovascular adverse effects that may occur during treatment with the different categories of psychotropic drugs and the differences between single drugs within each category are reviewed. The main adverse reactions reported during psychotropic drug treatments are, in order of prevalence, (1) arrhythmias, since antidepressants and neuroleptics affect several ion channels involved in the control of cardiac action potentials and thus exert a proarrhythmic activity; (2) changes in blood pressure; (3) impairment of ventricular function; and (4) thromboembolism. Benign arrhythmias and orthostatic hypotension are the most common and most manageable adverse effects. Arrhythmias, including torsades de pointes, and impairment of ventricular function may lead to sudden death whoseodds ratio for the antipsychotics ranges between 1.72 for quetiapine and 3.67 for clozapine. The risk of cardiovascular adverse effects is higher for the typical antipsychotics than for the atypical. Among the latter, clozapine prescription requires particular attention. Tricyclic antidepressants and lithium are frequently accompanied by dysrhythmias, including QT interval prolongation, but sudden death is a rare event. A marginal risk of myocardial infarction during antidepressant therapy exists, but the risk of cardiovascular adverse effects with non-tricyclic antidepressants is remarkably low and practically nonexistent for the mood modifiers, except lithium and anxiolytics.