Psychotropic medications are serious treatments for serious illnesses. Whilst often effective in the medically fit population, they frequently produce disappointing efficacy outcomes in the medically unwell.

Their use is also made more difficult by wide-ranging side effects which may complicate management or worsen symptoms or disease pathology of physical illnesses. Medical illnesses themselves may impact on the pharmacokinetics and pharmacodymanics of psychiatric medications, with implications for their effectiveness and safe use.

The availability of information to guide the clinician through drug choice for these patients is limited; research trials frequently exclude the medically unwell, guidelines are written for those without comorbidity, and where policies do exist, they do not account for the multimorbidity frequently seen in real-world practice. Further, prescribing and management of psychotropic medicines in non-mental health specialist settings may be fraught with practical difficulties, including access to medication and experience with its use.

This course will discuss choice of antidepressant in patients with heart failure, including those with comorbid conditions such as cardiac disease and diabetes. The evidence base for the safe and effective use of antidepressants in the cardiac patient will be discussed, as well as drug interactions, relative contraindications, and management of side effects.