76 - References

References

Depression and anxiety disorders CHAPTER 3 SSRIs are generally recommended in cardiac disease but beware anti-­platelet activity and CYP-­medicated interactions with co-­administered cardiac drugs. Mirtazapine has been suggested as a suitable alternative60 but it is also associated with bleeding disorders.61 SSRIs may protect against myocardial infarction (MI),62,63 and untreated depression worsens prognosis in cardiovascular disease.64 Post MI, SSRIs and mirtazapine have either a neutral or beneficial effect on mortality.65 Treatment of depression with SSRIs should not therefore be withheld post MI. Protective effects of treatment of depression post MI appear to relate to antidepressant administration, possibly because of an anti-­ coagulant effect or because of indirect reduction in arrhythmia frequency.42,66 CBT may be ineffective in this respect.67,68 Note that the anti-­platelet effect of SSRIs may have adverse consequences too (see section on SSRIs and bleeding in this chapter). References

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