Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach

Abstract

Patients with schizophrenia (SCZ) are at high risk of cardiovascular disease (CVD) due to an inherited predisposition, a sedentary life style and the use of antipsychotic medications. Several approaches have been taken to minimize this risk but results continue to be unsatisfactory. A potential alternative is prescribing selective serotonin reuptake inhibitors (SSRIs). SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression. We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ. A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ. Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine. Two of those studies found improvements with fluvoxamine. Of the other two reports, one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol, low-density lipoprotein and triglyceride. The second report suggests that when SSRIs are combined with antipsychotics, the metabolic impact depends on the antipsychotic prescribed. While there are promising results, no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ. Further studies are needed to resolve this matter.

Keywords: Antidepressants, Metabolic syndrome, Cholesterol, Psychotic disorders, Antipsychotics, Body weight

Core Tip: We searched MEDLINE and Google Scholar to find articles related to the cardiovascular effects of selective serotonin reuptake inhibitors (SSRIs) in patients with schizophrenia (SCZ) who are taking antipsychotics. We found evidence showing that fluvoxamine reduces metabolic factors in patients taking clozapine, but we also found that SSRIs as a group cause significant yet small increments in metabolic factors. There is also evidence that the effect of SSRIs on metabolic factors depends on which antipsychotics the patient is concurrently taking. Further research in this area is needed before any firm conclusion can be reached on whether SSRIs are beneficial or harmful for cardiovascular risk in SCZ.