Sertraline Cardiac Safety SADHART — MRCPsych Paper B MCQ

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HardLiaison PsychiatrySertraline Cardiac Safety SADHARTMRCPsych Paper B

A 50-year-old man meets criteria for a moderate depressive episode 3 weeks after a myocardial infarction. He has no other life-threatening medical condition, and treatment with an SSRI is being considered. Which SSRI has direct randomised, placebo-controlled cardiac safety evidence in patients with recent myocardial infarction or unstable angina, including no significant adverse effect on left ventricular ejection fraction, ventricular ectopy or QTc interval?

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Correct answer: A — Sertraline

Sertraline is correct. The SADHART randomised controlled trial studied sertraline in 369 patients with major depression following acute myocardial infarction or unstable angina. Compared with placebo, it caused no significant deterioration in left ventricular ejection fraction, ventricular premature complex runs, QTc interval or other measured cardiac outcomes. Current UK NHS medicines guidance therefore identifies sertraline as the first-line antidepressant in coronary heart disease. Fluoxetine and paroxetine are possible alternatives but do not have the same directly relevant SADHART evidence. Citalopram is less preferred in coronary heart disease because it causes dose-dependent QT prolongation and may require ECG monitoring. Fluvoxamine has a comparatively burdensome interaction profile and is not a preferred cardiac option.

Reference: NHS Specialist Pharmacy Service. Choosing an antidepressant for people with coronary heart disease. Updated 29 April 2025. https://sps.nhs.uk/articles/choosing-an-antidepressant-for-people-with-coronary-heart-disease/