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Drug Interactions in the Treatment of Depression in Patients With Ischemic Heart Disease

J Clin Psychiatry 2012;73(12):e1475-e1477
10.4088/JCP.12f08248

Depression and ischemic heart disease commonly coexist, and each can worsen the course and outcome of the other. Depression is commonly treated with selective serotonin reuptake inhibitors (SSRIs), and ischemic heart disease patients commonly receive aspirin and/or clopidogrel. SSRIs can interact with these antiplatelet treatments in 2 ways. First, SSRIs can increase the risk of bleeding events with antiplatelet therapy; this risk may be diminished by the administration of a proton pump inhibitor. Second, fluoxetine and fluvoxamine may inhibit the metabolic activation of clopidogrel, thereby potentially diminishing the efficacy of clopidogrel. Issues related to these drug interactions are discussed.