Curr Probl Cardiol. 2026 Jun 7:103385. doi: 10.1016/j.cpcardiol.2026.103385. Online ahead of print.
ABSTRACT
Heart failure (HF) commonly coexists with psychiatric disorders, particularly depression and anxiety, which significantly worsen prognosis and complicate treatment. Approximately 25 million Europeans suffer from anxiety disorders and 21 million from depression, while clinically significant depression affects up to 21.5% of patients with chronic HF. Because both cardiovascular and psychotropic medications may influence haemodynamic stability, electrolyte balance, and cardiac conduction, pharmacotherapy in this population requires careful monitoring and an interdisciplinary treatment approach. To analyse the available scientific literature on the use of psychopharmacotherapy in patients with HF who present with co-occurring depressive and/or anxiety disorders, and to formulate practical clinical guidance for physicians managing these patients. This narrative review was based on a targeted literature search conducted in PubMed/MEDLINE, Scopus, and Google Scholar, including publications from 1984 to 2025, with emphasis on recent evidence and clinical guidelines. Priority was given to systematic reviews, meta-analyses, randomised clinical trials, and studies addressing cardiovascular safety and drug interactions in psychopharmacotherapy. This review summarises major drug classes used in HF and in the treatment of depression and anxiety, drawing on clinical and experimental studies with emphasis on relevant pharmacological mechanisms. It highlights risk patterns, supports the selection of safer therapeutic combinations, and outlines monitoring strategies that may reduce adverse events. A safe pharmacological approach requires avoiding agents with high interaction potential (paroxetine, fluoxetine, tricyclic antidepressants) and preferentially using agents with a more favourable safety profile (sertraline, escitalopram, mirtazapine). Key findings, including recommended monitoring considerations and therapeutic implications, are summarised in Tables 1 and 2.
PMID:42259462 | DOI:10.1016/j.cpcardiol.2026.103385