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Chávez-Castillo et al. Vessel Plus 2018;2:6 Vessel Plus
DOI: 10.20517/2574-1209.2018.02

Review Open Access

Metabolic risk in depression and treatment
with selective serotonin reuptake inhibitors:

are the metabolic syndrome and an increase in
cardiovascular risk unavoidable?

Mervin Chávez-Castillo , Ángel Ortega , Manuel Nava , Jorge Fuenmayor , Victor Lameda , Manuel Velasco ,
1
1
1
1,2
1
3
Valmore Bermúdez , Joselyn Rojas-Quintero 1,5
1,4
1 Endocrine and Metabolic Diseases Research Center, School of Medicine, The University of Zulia, Maracaibo 4001, Venezuela.
2 Psychiatric Hospital of Maracaibo, Maracaibo 4001, Venezuela.
3 Department of Pharmacology, “JM Vargas” Medical School, Central University of Venezuela, Caracas 1050, Venezuela.
4 Advanced Frontier Studies Research Group (ALEF), Simón Bolívar University, Cúcuta 540006, Colombia.
5 Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA.
Correspondence to: Dr. Mervin Chávez-Castillo, Endocrine and Metabolic Diseases Research Center, School of Medicine, The
University of Zulia, Maracaibo 4001, Venezuela. E-mail: mervinch12@gmail.com
How to cite this article: Chávez-Castillo M, Ortega Á, Nava M, Fuenmayor J, Lameda V, Velasco M, Bermúdez V, Rojas-Quintero J.
Metabolic risk in depression and treatment with selective serotonin reuptake inhibitors: are the metabolic syndrome and an
increase in cardiovascular risk unavoidable? Vessel Plus 2018;2:6. http://dx.doi.org/10.20517/2574-1209.2018.02
Received: 2 Feb 2018 First Decision: 2 Apr 2018 Revised: 3 Apr 2018 Accepted: 9 Apr 2018 Published: 18 Apr 2018

Science Editor: Alexander D. Verin Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Depression is one of the most common psychiatric disorders, and has become an epidemic in modern medical practice;
notorious for frequently co-occurring with multiple comorbidities, especially cardiovascular disease (CVD), type 2
diabetes mellitus (DM2), and its various risk factors comprised in the metabolic syndrome (MS). Selective serotonin
reuptake inhibitors (SSRIs) are the most widely used class of psychotropic drugs in this and many other clinical
scenarios; yet their impact on cardiometabolic health has not been elucidated. The objective of this review was to
summarize current views on the pharmacology of SSRIs and cardiometabolic risk, as well as available epidemiological
evidence regarding its clinical significance. SSRIs appear to intervene in cardiometabolic physiology fundamentally by
modulating chronic inflammation, a key pathophysiologic phenomenon in MS, DM2 and CVD. However, the dosing
necessary to achieve a beneficial impact in this regard, as well as their clinical correlations, remain controversial.
Each SSRI displays a particular profile regarding each of the components of the MS: weight gain seems to be the
most common effect of SSRIs, more frequent with paroxetine, followed by citalopram and escitalopram. As a drug
class, SSRIs also appear to promote hypercholesterolemia rather uniformly, while fluoxetine and citalopram appear
to particularly increase triacylglyceride levels. In contrast, fluvoxamine and paroxetine seem to have the greatest
impact on dysglycemia. Lastly, most SSRIs appear to be innocuous or even beneficial regarding blood pressure and
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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