Older Type of Antidepressants Found to Double Heart Attack Risk
"The history of [tricyclics] that indicates they should be used with caution -- if at all -- in those patients with [heart] problems is strengthened by this data," says Cohen. "In the past, this concern has only been in people with very specific kinds of problems with their hearts [namely, heart rhythm irregularities]. This data suggests that we may want to expand this caution to include any [heart] disease."
Not everyone is so concerned about the study results, however. "I would tell my patients to not worry about the outcomes of this study," William H. Coryell, MD, professor of psychiatry at the University of Iowa in Iowa City, tells WebMD in an interview seeking objective analysis of the findings. "They could have gotten these results from reasons other than an increased risk for [heart attack] with these drugs. Placement on tricyclics may have been an indication of treatment resistance which, in turn, shares some risk factors with [heart] disease."
Richard M. Carney, PhD, professor of medical psychology at the Washington University Medical School in St. Louis, notes that a number of studies show there are heart-related side effects to tricyclics, while the SSRI profile in this respect is relatively clean.
"Generally speaking, given a choice between a [tricyclic] and an SSRI, I would opt for the SSRI," he says in an interview with WebMD. "Many patients with heart disease also do well with psychotherapy, which is another consideration that was not addressed by the article. Although it is important to express concerns about medication with their physician, this study does not give people taking a [tricyclic] any reason to panic or stop their medications."