Vol 9, No 1- Neuropsychiatry and Cardiovascular Disease
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ardiovascular medications may cause,exacer- bate,or relieve neuropsychiatric symptoms.Historically, a host of medications with effects on the cardiovascular system have been associated with the development of depression,anxiety,psychosis,or delirium,while others have been thought to have antidepressant or antimanic effects.However,there are several factors that make it difficult to confirm whether a given cardiovascular med- ication causes a given neuropsychiatric symptom. First,neuropsychiatric symptoms are exceedingly common among patients with cardiovascular conditions.For exam- ple,approximately 15% of patients with recent myocardial infarction (MI),congestive heart failure (CHF),or recent coronary artery bypass graft (CABG) surgery suffer from major depressive disorder (MDD).1-3Anxiety is also com- mon among patients with coronary artery disease (CAD), especially among post-MI patients.2,4,5Finally,delirium, which can present with psychotic symptoms,mood lability, and anxiety,is highly prevalent among hospitalized cardiac patients,especially among those undergoing surgery.6Thus, it may appear that a particular cardiovascular medication frequently causes a particular neuropsychiatric syndrome, when in fact such a syndrome may occur commonly as part of the natural history of cardiac illness,and be unrelated to medication.In addition,the vast majority of studies that associate cardiovascular medications with neuropsychiatric consequences have been case reports and case series that may at best suggest a link between the taking of a medica- tion and a clinical outcome.Such reports do not usually use standardized tools to evaluate the presence or severity of the reported neuropsychiatric symptoms;instead,they rely only on general reports of symptoms as observed by the authors.As we will discuss,well-controlled trials that exam- ine the neuropsychiatric consequences of cardiovascular medications are relatively few and far between,and at times may contradict clinical reports. P h a r m a c o l o g i c a l  a s p e c t s C Copyright © 2007 LLS SAS. All rights reserved www.dialogues-cns.org Neuropsychiatric consequences of cardiovascular medications Jeff C.Huffman,MD;Theodore A.Stern,MD Keywords:cardiovascular agent; adverse effect; neurologic manifestation; mood disorder; psychotic disorder; delirium; fatigue Author affiliations:Department of Psychiatry, Massachusetts General Hospital, Boston, Mass, USA; Harvard Medical School, Boston, Mass, USA Address for correspondence:
Jeff C. Huffman, MD, Massachusetts General Hospital, 55 Fruit Street/Warren 1220C, Boston, MA 02114, USA (e-mail: jhuffman@partners.org) The use of cardiovascular medications can have a variety of neuropsychiatric consequences. Many cardiovascular agents cause higher rates of fatigue and sedation than placebo, and case reports of medication-induced mood syndromes, psychosis, and cognitive disturbances exist for many car- diovascular drugs. Depression has been associated with - blockers, methyldopa, and reserpine, but more recent syn- theses of the data have suggested that these associations are much weaker than originally believed. Though low cholesterol levels have been associated with depression and suicide, lipid-lowering agents have not been associated with these adverse effects. Finally, cardiovascular medica- tions may have beneficial neuropsychiatric consequences; for example, the use of clonidine in patients with attention deficit-hyperactivity disorder, the use of prazosin for patients with post-traumatic stress disorder, and the use of propranolol for performance anxiety and akathisia. © 2007, LLS SAS Dialogues Clin Neurosci. 2007;9:29-45.