Selective serotonin reuptake inhibitors exhibit distinct cardiometabolic risk profiles, commonly promoting weight gain and hypercholesterolemia, while effects on dysglycemia vary by specific agent.
Do selective serotonin reuptake inhibitors (SSRIs) increase cardiometabolic risk and metabolic syndrome components in patients with depression?
SSRIs have varying but significant impacts on cardiometabolic risk factors, including weight gain, hypercholesterolemia, and dysglycemia, which should be considered in clinical practice.
Depression is one of the most common psychiatric disorders, and has become an epidemic in modern medical practice; notorious for frequently co-occurring with multiple comorbidities, especially cardiovascular disease (CVD), type 2 diabetes mellitus (DM2), and its various risk factors comprised in the metabolic syndrome (MS). Selective serotonin reuptake inhibitors (SSRIs) are the most widely used class of psychotropic drugs in this and many other clinical scenarios; yet their impact on cardiometabolic health has not been elucidated. The objective of this review was to summarize current views on the pharmacology of SSRIs and cardiometabolic risk, as well as available epidemiological evidence regarding its clinical significance. SSRIs appear to intervene in cardiometabolic physiology fundamentally by modulating chronic inflammation, a key pathophysiologic phenomenon in MS, DM2 and CVD. However, the dosing necessary to achieve a beneficial impact in this regard, as well as their clinical correlations, remain controversial. Each SSRI displays a particular profile regarding each of the components of the MS: weight gain seems to be the most common effect of SSRIs, more frequent with paroxetine, followed by citalopram and escitalopram. As a drug class, SSRIs also appear to promote hypercholesterolemia rather uniformly, while fluoxetine and citalopram appear to particularly increase triacylglyceride levels. In contrast, fluvoxamine and paroxetine seem to have the greatest impact on dysglycemia. Lastly, most SSRIs appear to be innocuous or even beneficial regarding blood pressure and high-density lipoprotein cholesterol. Nevertheless, many of these effects may vary significantly upon specific clinical circumstances, especially timing. This topic remains rather unexplored in clinical psychopharmacology, and further, larger-scale epidemiological studies are needed in order to offer improved care in this field.
Chávez-Castillo et al. (Wed,) conducted a review in Depression. Selective serotonin reuptake inhibitors (SSRIs) was evaluated. Selective serotonin reuptake inhibitors exhibit distinct cardiometabolic risk profiles, commonly promoting weight gain and hypercholesterolemia, while effects on dysglycemia vary by specific agent.