The Risk of Fatal Arrhythmias Associated With Sertraline in Patients With Post-myocardial Infarction Depression

Abstract

Sertraline is a first-line antidepressant and the most commonly used in the treatment of selective serotonin reuptake inhibitor (SSRI) in major depression. It is preferred due to its central and peripheral actions on the serotonergic system in patients with mental health issues as well as cardiovascular disease, particularly post-myocardial infarction depression. Some of the feared adverse effects include QT prolongation, arrhythmias including Torsades de pointed, and sudden cardiac death, which are associated with older antidepressants and are rarely seen with SSRIs, including sertraline. We tried to understand the risks associated with sertraline use in cardiac patients. We reviewed all the relevant information from inception up to July 2022 regarding the risks of sertraline use in cardiovascular diseases, particularly with a focus on post-myocardial infarction depression, and gathered around 500 articles in our research and narrowed it down to 37 relevant articles. The database used was PubMed and the keywords used are sertraline, arrhythmia, major depression, post-myocardial infarction, and ventricular tachycardia. We carefully screened all relevant articles and found articles supporting and refuting the effects of sertraline in increasing cardiovascular morbidity and mortality. We concluded that there is a significant variability due to confounding factors affecting individual cases. Overall, sertraline has no increased risk in comparison with other antidepressants and a comparatively preferable safety profile to other SSRIs like citalopram in general cases. Any patient with a high risk of arrhythmias due to any etiology should receive a screening ECG before sertraline prescription for baseline QT interval and genotyping for any serotonin transporter/receptor variations. Patients should also be periodically monitored for drug-drug interactions while on therapy. We encourage further research, including randomized clinical trials and post-marketing surveillance regarding the use of sertraline in high-risk cases.

Keywords: cardiovascular disease; depression; life threatening arrhythmia; mental health illness; post-myocardial infarction; sertraline; ventricular tachycardia (vt).

Figure 1. Overlapping pathological spheres of cardiovascular disease, major depression, obesity and metabolic syndrome

Figure 2. The factors affecting QT interval prolongation

Figure 3. Important effects of serotonin

Figure 4. The common adverse effects of sertraline