If you live with heart disease and also struggle with depression, anxiety, or another psychiatric condition, it can feel like your medications are fighting each other. Patients often ask us at Advanced Psychiatry Associates across California:
=> Are antidepressants safe with my heart condition?
=> Will this medication raise my blood pressure?
=> Do I need an EKG before starting this?
This guide focuses purely on the medical side of psychiatric medications and cardiac risk, so you can see how our psychiatrists across California think about:
Antidepressants in heart disease
Blood pressure and psychiatric meds
QT prolongation and EKG monitoring
Antipsychotics, cholesterol, and weight
How we coordinate with cardiology and primary care
All of this sits inside APA’s structured Medication Management program.
Why treating depression and anxiety helps your heart
Depression and anxiety are more common in people with coronary artery disease (CAD), heart failure, and arrhythmias, and they’re not just emotional side stories. Research from the American Heart Association and others shows that untreated depression can worsen cardiac outcomes, reduce treatment adherence, and increase hospitalizations.
The AHA has specifically stated that SSRIs (selective serotonin reuptake inhibitors) are generally safe in patients with coronary heart disease and can reduce depression while improving adherence to cardiac treatment.
So the real question isn’t “meds vs. no meds,” it’s which psychiatric medications are safest for your heart condition, and how do we monitor them?
At APA, that’s exactly the lane of our Depression and Anxiety services, backed by careful med management.
Antidepressants and heart disease: SSRIs vs SNRIs
SSRIs: often the first choice for heart patients
For many people with depression and heart disease, SSRIs are the starting point. Large guidelines and reviews consistently note:
SSRIs are the most studied antidepressants in cardiac populations.
They are generally considered safe for people with coronary heart disease at standard doses.
Sertraline is frequently recommended as a first-line option for patients with CHD because it has few cardiac side effects and minimal interactions with cardiac drugs.
Key cardiac points with SSRIs:
Blood pressure: usually neutral, with small changes at most.
Heart rhythm: most SSRIs have low QT-prolongation risk at typical doses, but:
Citalopram and escitalopram can prolong the QT interval at higher doses; regulators recommend dose limits and extra caution in cardiac patients or those with existing QT prolongation.
At APA in California, if you have known heart disease, we lean toward agents with strong safety data in CHD, like sertraline, and adjust based on your prior response and cardiologist’s input.
SNRIs: watch the blood pressure
SNRIs, like venlafaxine and duloxetine, can be very effective but have more impact on blood pressure and heart rate:
They can raise BP or HR, especially at higher doses.
We are extra cautious in patients with uncontrolled hypertension, arrhythmias, or recent cardiac events.
That doesn’t mean SNRIs are forbidden; it means they require closer BP monitoring and cardiology-aware prescribing, something built into our Medication Management follow-ups.
QT prolongation, EKGs, and dangerous heart rhythms
Some psychiatric medications can prolong the QT interval on an EKG. A significantly prolonged QT can, rarely, lead to a dangerous rhythm called torsades de pointes and even sudden cardiac death.
Major QT-related factors we look at:
Existing heart disease or congenital long QT syndrome
Low potassium or magnesium (electrolyte problems)
Use of other QT-prolonging drugs (some antiarrhythmics, certain antibiotics, etc.)
High doses or IV forms of certain antipsychotics
Age, liver/kidney disease
From a psychiatric perspective:
Nearly all antipsychotics and several antidepressants can prolong QT to some degree, but the risk varies widely by drug and dose.
Higher-risk examples include:
TCAs and some older antidepressants
Certain antipsychotics (e.g., ziprasidone, high-dose haloperidol IV)
At APA, we typically:
Obtain a baseline EKG if:
You have known heart disease, syncope, or arrhythmias
You’re on other QT-prolonging medications
We’re using a psych med known to significantly affect QT
Repeat EKGs when:
We increase to higher doses
You start or stop another QT-affecting drug
That’s what we mean by EKG monitoring for psychiatric meds, not to scare you, but to make informed, measured decisions.
Antipsychotics, weight, cholesterol, and heart risk
Antipsychotic medications that are used for conditions like bipolar disorder, psychosis, severe agitation, or augmentation in treatment-resistant depression affect the heart in two big ways:
Electrical effects: QT prolongation
Metabolic effects: weight, cholesterol, blood sugar
Reviews in cardiology and psychopharmacology note that antipsychotics can contribute to cardiometabolic risk, weight gain, dyslipidemia, and insulin resistance, over time, especially with certain second-generation agents.
Our approach at APA when antipsychotics are needed:
Prefer agents with lower metabolic and QT risk when feasible.
Monitor:
Weight and BMI
Fasting glucose / A1c
Lipid panel
Blood pressure
EKGs as indicated
This is especially important if you already have:
Coronary artery disease or prior heart attack
Heart failure
Significant arrhythmia risk
Strong family history of sudden cardiac death
For many patients with severe bipolar disorder or psychosis, not treating illness carries a higher immediate risk than these long-term side effects, so the goal is careful choice and monitoring, not avoidance at all costs.
You can see our broader Bipolar Disorder and Alzheimer’s/Late-Stage Dementia services, where antipsychotics are often considered
Blood pressure, anxiety meds, and other cardiac interactions
Some psych meds are quietly cardioactive even if they’re not famous for it:
SNRIs and some activating antidepressants can increase BP and HR.
Stimulants (for ADD/ADHD) raise HR and BP and require special caution in patients with structural heart disease or arrhythmias.
Some antipsychotics and mood stabilizers can contribute to weight gain and metabolic syndrome, indirectly affecting blood pressure and vascular health.
On the flip side, many heart patients are on:
Beta-blockers, calcium-channel blockers, antiarrhythmics
Anticoagulants and antiplatelet agents
Complex combinations for heart failure or post-MI care
At APA, we don’t prescribe in a vacuum. Every Medication Management visit includes:
A full medication list (psychiatric + cardiac + everything else)
Checking for drug–drug interactions (e.g., meds that raise levels of each other, both prolong QT, or both lower blood pressure)
Adjusting doses or changing agents to match your cardiology plan
How Advanced Psychiatry Associates works with your cardiologist
Psychiatric care for heart patients works best when everyone shares the same playbook. Across APA’s California locations, our psychiatrists routinely:
Communicate with cardiologists and primary care about:
Planned antidepressant or antipsychotic choices
EKG findings, blood pressure changes, and lab results
Symptoms like palpitations, dizziness, syncope, or worsening chest discomfort
Use structured Medication Management follow-ups to:
Check vitals, side effects, and weight
Review cardiac test results
Adjust meds as your heart condition evolves
Tie psychiatric diagnoses into our core service lines:
You can find all clinics here:
👉 Our Offices
👉 Schedule an Appointment
