Illnesses don’t look in the face of anyone, not even those that compromise the mental health. For example, they have suffered and suffer from depression ordinary people and world-famous stars, including athletes. The list is long and includes, among others, the coach and former footballer Thierry Henrythe former Atalanta attacking midfielder Josip Ilicicthe swimmer Michael Phelpsthe former NBA basketball player Ricky Rubio and gymnast Simone Biles. To treat this pathology, a class of drugs has also been used for about 15 years, called selective serotonin reuptake inhibitors (SSRIs), which initially seemed to favor heart problems, a side effect that a large study has reduced.
the role of serotonin
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The main mediator of anxious-depressive conditions is serotoninneurotransmitter released by nerve endings present mainly in the central nervous systembut also in some peripheral systemsparticularly in theintestine. This substance, whose production is also favored byphysical activityis involved in various mechanisms: it has a fundamental role in the rhythm of sleepin appetite, in sexual desire and a less central role in other processes, including the blood clotting and the renewal of bone tissue. One of the most important functions of serotonin, also defined as the hormone of happiness and well-being, is to regulate emotions. Any imbalances (not only deficiencies, but also excesses) alter mood, favoring the appearance of depression. After the body releases it, this neurotransmitter performs its function, then it is reabsorbed. “The mechanism of action of SSRI drugs consists of limit the reabsorption of serotonin. Since higher levels of this hormone increase mood, these drugs are effective against depression” explains the Dr. Giorgio Serinoimmunologist and allergist at the Irccs Policlinico San Donato and at the Casa di Cura la Madonnina in Milan.
Depression is bad for the heart
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American research carried out shortly after the introduction of SSRIs for the treatment of depression highlighted that these drugs have negative effects on the cardiovascular systemwhich is why doctors could prescribe them only after careful checks on patients’ cardiac health. Recently, a study carried out in Denmark reworked the data from the US research and carried out another survey on a new sample, reaching a different conclusion, namely that the increased cardiovascular risk was not a consequence of the use of SSRIs, but rather of previous anxiety and depression. “Those who suffer from this disease tend to eat and smoke more, as well as reduce social contacts and physical activity, becoming sedentary and overweight. These are bad habits to have negative effects on the cardiovascular healthnot SSRIs,” notes Dr. Serino.
ssri in the right doses
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Given this, if prescribed when it is not necessary or if used at too high doses, SSRIs can have side effects. Excesses of serotonin have negative consequences not only on the cardiovascular system, favoringincrease in blood pressure and of heart rate, but also on the intestinal one, as they can give rise to nausea, diarrhea and meteorism. “If your doctor or internist correctly prescribes SSRIs to treat depression, they are usually enough a few weeks for the situation to improve significantly. With the consequent increase in mood, the cardiovascular risk is also reduced, because we are less likely to follow the bad habits favored by depression” underlines Dr. Serino. Another class of antidepressants has negative effects on the heart (even annoying arrhythmias) and circulation, namely tricyclics. It is therefore essential for their prescription a careful cardiological evaluation. However, tricyclics can also be used in combination with SSRIs.
