Sertraline Cardiac Safety — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

HardLiaison PsychiatrySertraline Cardiac SafetyMRCPsych Paper B

A patient develops a major depressive episode shortly after hospital admission with an acute myocardial infarction. Which antidepressant has direct placebo-controlled trial evidence in patients with recent myocardial infarction or unstable angina showing no significant adverse effect on left ventricular ejection fraction, ventricular ectopy or QTc interval?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Sertraline

The correct answer is sertraline. In SADHART, patients with major depression following recent myocardial infarction or unstable angina were randomised to sertraline or placebo. Sertraline produced no significant deterioration in left ventricular ejection fraction, ventricular ectopy, QTc or other measured cardiac outcomes. This provides unusually direct safety evidence for this specific clinical population. Citalopram is an SSRI with relatively few pharmacokinetic interactions, but it has dose-dependent QT-prolongation concerns and was not the drug tested in SADHART. Fluoxetine and paroxetine lack equivalently direct randomised safety evidence in recent acute coronary syndrome, while venlafaxine is less attractive where cardiovascular safety is central because it can raise blood pressure and heart rate. Individual bleeding, interaction and QT-risk factors must still be assessed.

Reference: Glassman AH et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288(6):701–709. https://pubmed.ncbi.nlm.nih.gov/12169073/