What Should a Cardiologist Know About Psychiatric Medications? A Narrative Review of Cardiovascular Safety, Monitoring, and Clinical Management

Abstract

Background: Psychotropic medications including antipsychotics and antidepressants, are among the most commonly prescribed medications. Despite the use of newer-generation agents, cardiovascular (CV) side effects still affect patients using these medications. They are widely used for the treatment of bipolar disorder, major depressive disorder, anxiety disorders, schizophrenia and many other psychiatric conditions. Many of these medications are associated with CV adverse effects ranging from mild orthostatic hypotension to life-threatening arrhythmias, myocarditis, and metabolic complications. Currently, There are more people and more indications for using antipsychotics, so, cardiovascular side effects should be studied properly. Objective: The aim of this review is to summarizes the current evidence regarding the CV side effects of antipsychotic and antidepressant medications, explores the underlying pathophysiological mechanisms, compares the CV safety profiles of different drug classes, and discusses practical strategies for CV risk assessment, monitoring, and clinical management. Methods: We conducted literature review by searching major biomedical databases, including PubMed, Scopus and Google Scholar, for relevant articles related to our topic, including recent articles. Original studies, systematic reviews, meta-analyses and clinical practice guidelines addressing CV complications associated with psychotropic drugs were reviewed. Results: Cardiovascular adverse effects vary considerably among psychotropic medications. Antipsychotic drugs are associated with QT interval prolongation, torsades de pointes ventricular arrhythmias, metabolic syndrome, orthostatic hypotension, myocarditis and cardiomyopathy. Antidepressants have class-specific CV effects especially conduction abnormalities with tricyclic antidepressants. Selective serotonin reuptake inhibitors have a relatively favourable CV profile. The risk of adverse cardiovascular outcomes was influenced by several factors including patient-related factors, concomitant medications, electrolyte abnormalities, and presence of CV disease. Conclusion: In order to minimize CV morbidity and mortality, psychotropic medications should be carefully selected, CV risk assessment should be individualized, appropriate electrocardiographic, metabolic monitoring, and early recognition of adverse effects are essential. Collaboration between psychiatrists, cardiologists, primary care physicians, and clinical pharmacists is essential for optimizing treatment outcomes and maintaining CV safety.