El potencial papel “protector” de los ISRS en pacientes postinfartados con depresion mayor: Nota clinica

In the last years, Major-Depression (MD) without a correct diagnosis or treatment has acquired a significative role as an independent coronary risk factor, similar to the classical vascular risk factors. Therefore, it is necessary a praecox diagnosis and treatment of MD performed by psychiatrist or clinical psychologist, in the setting of multidisciplinary hospital teams of Cardiac Rehabilitation. We presented a case-report of melancholic, Major Depression (MD) post-myocardial infarction, successfully treated with SSRI (ciatalopram). Focused on this case-report, the discussion is directed to the security, efficacy and potential “protective” action of these drugs (SSRI) in coronary patients: Action on neuroinflammatory pathways mediated by MD; antithrombogenic effect of SSRI mediated by platelets´ 5-HT; reduction of cellular apoptosis in both hippocampal cells and myocardiocyte in experimental, animal models of MD; security of SSRI in anticoagulated patients but caution in antiaggregated ones (Clopidogrel or double antiaggregation) combined with fluvoxamine and fluoxetine (CYP2C19 metabolim); and improvement of cardiac functionalism variables by an independent mechanism of SSRI antidepressant action..