Anti depressant of choice Post MI (5/1700)

A 64yo man has recently suffered from a MI and is on aspirin, atorvastatin and ramipril. He has
been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel
like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and
can’t concentrate on anything. What is the most appropriate tx?
a. Lofepramine
b. Dosulepin
c. Citalopram
d. Fluoxetine
e. Phenelzine












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C....citalopram/sertaline are best post MI

NICE have given guidance as to the treatment of depression in the context of heart disease (1).

• when initiating treatment in a patient with a recent myocardial infarction or unstable angina, sertraline is the treatment of choice as it has the most evidence for safe use in this situation
• take account of the increased risks associated with tricyclic antidepressants in patients with cardiovascular disease
  • an ECG should be carried out and blood pressure measurement taken before prescribing a tricyclic antidepressant for a depressed patient at significant risk of cardiovascular disease
• venlafaxine and tricyclic antidepressants should not be prescribed for patients with a:
  • high risk of serious cardiac arrhythmias
  • recent myocardial infarction

In the updated NICE guidance (2):

• sertraline and citalopram are suggested as first choice SSRIs if depression occurs in a patient with a chronic physical health problem
  • for people who also have a chronic physical health problem, consider using citalopram or sertraline as these have a lower propensity for interactions
• if patient on flecainide or propafenone
  • offer sertraline as the preferred antidepressant
  • mirtazapine and moclobemide may also be used