Selective serotonin reuptake inhibitors: Future treatment of vascular disease? New evidence linking platelets, depression, and coronary events

There is substantial clinical evidence today that the incidence of depression and mortality after acute coronary syndromes are strongly related. The main effectors of coronary thrombosis are platelets, and hence, alterations of platelets and their functional characteristics may represent a conceptual bridge between these events. Selective serotonin reuptake inhibitors (SSRI), such as sertraline, have become an established therapy in patients with depression. These drugs provide not only a safe blockade of serotonin reuptake in the brain, but also in platelets, thus potentially protecting them from activation. However, the ability of sertraline therapy to deliver clinically meaningful antiplatelet effects and reduce thrombotic events, particularly acute coronary syndromes, is yet unexplored. Nevertheless, the platelet-related properties of SSRI may strongly affect the incidence of complications in patients with ischemic heart disease. Moreover, even marginal clinical benefits, together with recently reported severe bleeding events in some patients receiving oral platelet glycoprotein IIb/IIIa therapy, may potentially advance sertraline as a safe and efficient adjunct to the current therapeutic approach to the acute coronary syndrome. Further well-designed and carefully conducted clinical trials should elucidate the potential benefits of SSRI in an expanding array of clinical conditions, including myocardial infarction and unstable angina, with a prospect of SSRI to become suitable drugs, for example, in the convalescent phase of an ischemic event.