cardiovascular-agents and Mood-Disorders

Topics: Adaptation, Psychological; Arrhythmias, Cardiac; Automobile Driving; Cardiac Pacing, Artificial; Cardiovascular Agents; Clinical Trials as Topic; Combined Modality Therapy; Defibrillators, Implantable; Disease Management; Electric Countershock; Electric Injuries; Equipment Failure; Humans; Monitoring, Physiologic; Mood Disorders; Multicenter Studies as Topic; Pacemaker, Artificial; Patient Acceptance of Health Care; Patient Education as Topic; Psychotherapy; Quality of Life; Sports; Stress, Psychological; Telemedicine; Terminal Care; Withholding Treatment

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 cardiovascular drugs. Depression has been associated with P3-blockers, methyldopa, and reserpine, but more recent syntheses 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 medications 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.

Topics: Adrenergic beta-Antagonists; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Cardiovascular Agents; Cardiovascular Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Mental Disorders; Mood Disorders; Stress Disorders, Post-Traumatic

The authors prospectively investigated the incidence of asystole (absence of heartbeat for 5 seconds) in elderly patients receiving electroconvulsive therapy (ECT) at a university-based geriatric psychiatry unit. In all, 65.8% of patients experienced asystole at some time during their course of ECT. Those who experienced asystole were significantly younger (average age, 72.2) than those without asystole (average age, 77.0; P = 0.026) and were also less likely to have cardiac rhythm disturbances on electrocardiogram (P = 0.024). Medical history, history of cardiac disease, electrode placement, energy level, and number of ECT treatments did not predict asystole. Asystole is a common side effect of ECT in elderly patients. It was not associated with any untoward outcome. The fact that "old-old" patients and those with cardiac disease are less likely to experience asystole than younger, healthier patients is reassuring to practitioners of ECT.

Topics: Age Factors; Aged; Anesthetics; Cardiovascular Agents; Chi-Square Distribution; Electroconvulsive Therapy; Female; Geriatric Psychiatry; Heart Arrest; Heart Diseases; Humans; Male; Mood Disorders; Prospective Studies; Treatment Outcome