Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jul 19, 2021; 11(7): 316-324
Published online Jul 19, 2021. doi: 10.5498/wjp.v11.i7.316
Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach
Alfredo Bellon, Kieuhanh Nguyen
Alfredo Bellon, Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, PA 17033, United States
Kieuhanh Nguyen, Department of Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, United States
Author contributions: Nguyen K wrote the first draft and collected most of the information included in this manuscript; Bellon A envisioned and designed this manuscript, then retrieved further essential information and wrote the final draft.
Conflict-of-interest statement: The authors report no conflict of interest related to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Alfredo Bellon, MD, PhD, Assistant Professor, Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States.
Received: December 17, 2020
Peer-review started: December 17, 2020
First decision: March 30, 2021
Revised: May 16, 2021
Accepted: June 28, 2021
Article in press: June 28, 2021
Published online: July 19, 2021

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.