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Treating Major Depression associated with certain General Medical Conditions

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

Cardiovascular (Heart) Disease

Cardiovascular disease is associated with high rates of Depression, and Depression can both cause and worsen cardiovascular disease. Treating Depression in people with cardiovascular disease is thus important for improving not only their mental health but also their cardiovascular health [ref].

Sertraline, Fluoxetine, Citalopram, Bupropion and Mirtazapine appear to be safe to use after a heart attack, and in these cases the use of Sertraline, Citalopram and Mirtazapine has also been shown to reduce mortality [ref]. Paroxetine and Citalopram appear to be safe to use in patients with known coronary artery disease [ref].

Tricyclic Antidepressants are not recommended for use in people with heart disease, as these medications can have potentially dangerous side-effects on the cardiovascular system [ref]. Reboxetine, Duloxetine and Venlafaxine are known to increase blood pressure and should also be avoided [ref].

Neurological Conditions

For individuals with certain neurological conditions, such as having sustained a stroke or suffering from Parkinson's Disease, and who are also experiencing a Major Depressive Episode, there is some evidence that Tricyclic Antidepressants such as Nortriptyline are more effective than SSRI antidepressants for treating the Depression [ref, ref].


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Minor Depressive Episode