Pulmonary Stenosis is NOT a Contraindication to SSRIs
Pulmonary stenosis does not contraindicate the use of selective serotonin reuptake inhibitors (SSRIs), as there is no established pharmacological interaction or hemodynamic concern that would preclude their use in patients with this valvular lesion.
Evidence Base
The available evidence does not identify pulmonary stenosis as a contraindication to SSRI therapy:
A retrospective cohort study in pulmonary arterial hypertension (PAH) patients found that SSRI use did not significantly impact survival outcomes (HR, 0.53; 95% CI, 0.07-3.9; P = 0.53), though the study concluded there was insufficient evidence to recommend for or against SSRIs in PAH patients 1
Current guidelines for pulmonary hypertension and cardiovascular disease management do not list SSRIs among contraindicated medications for patients with pulmonary stenosis or right-sided valvular lesions 1
Pharmacological Considerations
SSRIs do not have direct hemodynamic effects that would worsen pulmonary stenosis:
SSRIs do not cause significant vasodilation, do not affect cardiac contractility, and do not alter heart rate in clinically meaningful ways that would compromise right ventricular function in pulmonary stenosis 1
Unlike medications with known cardiovascular contraindications in structural heart disease (such as immediate-release nifedipine without beta-blockers, or certain vasodilators), SSRIs are not mentioned in cardiovascular contraindication lists 1
Clinical Context
The distinction between pulmonary stenosis and pulmonary arterial hypertension is important:
Pulmonary stenosis is a fixed valvular obstruction at the level of the pulmonary valve, whereas pulmonary arterial hypertension involves elevated pressures in the pulmonary vasculature 2, 3
Even in PAH, where hemodynamic concerns are more pronounced, SSRIs are not contraindicated—they simply lack sufficient evidence for therapeutic benefit 1
Practical Management
When prescribing SSRIs to patients with pulmonary stenosis:
Monitor for standard SSRI side effects (gastrointestinal symptoms, sexual dysfunction, bleeding risk with concurrent antiplatelet therapy) rather than cardiac-specific concerns 1
Assess the severity of pulmonary stenosis independently, as severe stenosis may require intervention regardless of psychiatric medication needs 2
Consider potential drug interactions if the patient is on anticoagulation or antiplatelet therapy, as SSRIs can increase bleeding risk, but this is not specific to pulmonary stenosis 1
Common Pitfalls to Avoid
Do not confuse pulmonary stenosis with aortic stenosis—while severe aortic stenosis requires caution with certain antihypertensive medications, pulmonary stenosis does not share these same contraindications 1
Do not withhold indicated psychiatric treatment based on the presence of pulmonary stenosis alone, as there is no evidence-based rationale for this restriction 1