“Efficacy and Safety of Psychopharmacological Interventions for Heart Failure with Comorbid Depression/Anxiety: A Systematic Review.”

Abstract

Background

Depression and anxiety are highly prevalent among patients with heart failure (HF), significantly worsening quality of life, self-care behaviors, and mortality risk.

Psychopharmacological treatments, particularly antidepressants, are frequently prescribed; however, their cardiac safety and clinical efficacy remain debated.

Objective

This systematic review aimed to evaluate the efficacy and safety of antidepressant pharmacotherapy compared with psychotherapeutic and usual-care interventions in patients with HF or coronary artery disease (CAD) comorbid with depression or anxiety.

Methods

Following PRISMA 2020 guidelines, a systematic search was performed across PubMed, Scopus, Embase, Web of Science, and Google Scholar from 2000–2025. Eleven randomized controlled trials (RCTs) met inclusion criteria. Data were synthesized narratively across domains: antidepressant efficacy, comparative effectiveness with psychotherapy, cardiac safety, and quality of life.

Results

SSRIs (e.g., sertraline, citalopram, fluoxetine, escitalopram), and atypical antidepressants (mirtazapine, bupropion) all decreased symptoms of depression by 30 per cent to 50 per cent. Cognitive-behavioral therapy and behavioral activation had similar effects. Escitalopram lessened long-term major adverse cardiac events (HR = 0.69, p =.03). In trials, the antidepressants were tolerated positively with no major adverse outcomes in the cardiac system. Quality of life and symptom control were further increased with collaborative or nurse-led models of care..

Conclusions

Antidepressants are safe and effective in HF with comorbid depression or anxiety, especially with multidisciplinary and behavioural interventions. Individualized, joint interventions could maximize mental and cardiac performances.