Antidepressant Drugs Effects on Blood Pressure

Abstract

Individuals suffering from depressive disorders display a greater incidence of hypertension compared with the general population, despite reports of the association between depression and hypotension. This phenomenon may depend, at least in part, on the use of antidepressant drugs, which may influence blood pressure through different effects on adrenergic and serotoninergic pathways, as well as on histaminergic, dopaminergic, and cholinergic systems. This review summarizes extant literature on the effect of antidepressant drugs on blood pressure. Selective serotonin reuptake inhibitors are characterized by limited effects on autonomic system activity and a lower impact on blood pressure. Thus, they represent the safest class—particularly among elderly and cardiovascular patients. Serotonin–norepinephrine reuptake inhibitors, particularly venlafaxine, carry a greater risk of hypertension, possibly related to greater effects on the sympathetic nervous system. The norepinephrine reuptake inhibitor reboxetine is considered a safe option because of its neutral effects on blood pressure in long-term studies, even if both hypotensive and hypertensive effects are reported. The dopamine–norepinephrine reuptake inhibitor bupropion can lead to blood pressure increases, usually at high doses, but may also cause orthostatic hypotension, especially in patients with cardiovascular diseases. The norepinephrine–serotonin modulators, mirtazapine and mianserin, have minimal effects on blood pressure but may rarely lead to orthostatic hypotension and falls. These adverse effects are also observed with the serotonin-reuptake modulators, nefazodone and trazodone, but seldomly with vortioxetine and vilazodone. Agomelatine, the only melatonergic antidepressant drug, may also have limited effects on blood pressure. Tricyclic antidepressants have been associated with increases in blood pressure, as well as orthostatic hypotension, particularly imipramine. Oral monoamine–oxidase inhibitors, less frequently skin patch formulations, have been associated with orthostatic hypotension or, conversely, with hypertensive crisis due to ingestion of tyramine-containing food (i.e., cheese reaction). Lastly, a hypertensive crisis may complicate antidepressant treatment as a part of the serotonin syndrome, also including neuromuscular, cognitive, and autonomic dysfunctions. Clinicians treating depressive patients should carefully consider their blood pressure status and cardiovascular comorbidities because of the effects of antidepressant drugs on blood pressure profiles and potential interactions with antihypertensive treatments.

Acid Sphingomyelinase Inhibitor, Imipramine, Reduces Hippocampal Neuronal Death after Traumatic Brain Injury

“…Imipramine inhibits ASMase by reuptake of monoamines such as norepinephrine, dopamine, and serotonin. Additionally, imipramine has anti-inflammatory and antiapoptotic effects [ 47 , 48 ]. In this study, we found that imipramine administration reduced the number of degenerating neurons, oxidative damage, dendritic loss, glial activation, and cognitive dysfunction ( Figure 6 ).…”

Hypertension and depression among medical students: is there an association?

“…It is worth mentioning as well that the link between major depression and certain behavioral factors such as increased rates of smoking and physical inactivity might also contribute to the increased risk of hypertension among depressed individuals [ 23 ]. When treating depression, clinicians should carefully assess the blood pressure status since antidepressant medications might affect the blood pressure [ 9 ].…”

“…Depression might increase the risk for uncontrolled hypertension [ 8 ]. When treating depression, clinicians should also carefully assess the blood pressure status since antidepressant medications might affect the blood pressure [ 9 ].…”

The treatment of depression — searching for new ideas

“…(Abdel-Bakky et al, 2021;McCarron et al, 2021). Considering SSRIs, prolonged bleeding time, and, when used during pregnancy, heart defects and pulmonary hypertension in newborns have been observed (Berard et al, 2017;Calvi et al, 2021). For newer medications, such as those approved by the FDA for treatment of MDD, ansofaxine (potential triple reuptake inhibitor of serotonin, norepinephrine, and dopamine, approved in 2019) or vilazodone (a selective serotonin reuptake inhibitor and serotonin 5-HT1A receptor partial agonist, approved in 2021), the side effects are very similar to traditional antidepressants.…”