Pharmacotherapy of the Depressed Patient With Cardiovascular and/or Cerebrovascular Illness

SUMMARY Cardiovascular and cerebrovascular disease are associated with a high incidence of depressive disorder. Despite this high level of co‐morbidity, depressive disorders appear to go largely unrecognised and remain untreated. This may have serious consequences, as concomitant depression worsens the prognosis in patients with cardiovascular or cerebrovascular disease, increases medical costs, and delays return to work. Treatment with traditional tricyclic antidepressants is difficult in these patients because of the known cardiac effects. The favourable side‐effect profiles of the 5‐HT reuptake inhibitors suggest that they may offer therapeutic advantages, as they have little or no effect on cardiac conduction, do not cause orthostatic hypotension, and lack serious sequelae in overdose. The pharmacological profiles and the reduced potential of these newer antidepressant drugs to cause drug interaction show important differences that may be of clinical relevance in this patient population.