People suffering from depressive disorders may have a greater incidence of hypertension than the general population, despite reports of the association between depression and hypotension. This phenomenon may be partly due to the use of antidepressant drugs, which may affect blood pressure through different effects on adrenergic and serotoninergic pathways, along with histaminergic, dopaminergic, and cholinergic systems. 

A recent review summarized existent literature on the effect of antidepressant drugs on blood pressure. 

• Selective serotonin reuptake inhibitors are characterized by narrow effects on autonomic system activity and a lower impact on blood pressure. Thus, they depict the safest class, especially among elderly and cardiovascular patients. 
• Serotonin-norepinephrine reuptake inhibitors, especially venlafaxine, have a greater risk of hypertension, probably due to more prominent effects on the sympathetic nervous system. 
• The norepinephrine reuptake inhibitor reboxetine can be regarded as a safe choice due to its neutral effects on blood pressure in long-term studies, despite the reports on both hypotensive and hypertensive effects. 
• The dopamine–norepinephrine reuptake inhibitor bupropion can cause an increase in blood pressure, particularly at high doses, and may also cause orthostatic hypotension, mainly in patients with cardiovascular diseases. 
• The norepinephrine–serotonin modulators, mirtazapine, and mianserin, keep minimal effects on blood pressure but may sometimes cause orthostatic hypotension and falls. These adverse effects are also reported with the serotonin-reuptake modulators, nefazodone and trazodone, but rarely with vortioxetine and vilazodone. 
• Agomelatine which is the only melatonergic antidepressant drug may also show limited effects on blood pressure. 
• Tricyclic antidepressants, particularly imipramine, have shown an association with increases in blood pressure and orthostatic hypotension. 
• Oral monoamine–oxidase inhibitors, less often skin patch formulations, have shown an association with orthostatic hypotension or, conversely, with hypertensive crisis due to ingestion of tyramine-containing food. 

Thus, a hypertensive crisis tends to problematize antidepressant treatment as a part of the serotonin syndrome, also involving neuromuscular, cognitive, and autonomic dysfunctions. Hence, clinicians managing depressive patients should carefully assess their blood pressure status and cardiovascular comorbidities because of the influences of antidepressant drugs on blood pressure profiles and potential interactions with antihypertensive treatments.

Calvi A, Fischetti I, Verzicco I. et al. Antidepressant Drugs Effects on Blood Pressure. Front. Cardiovasc. Med.,2021. https://doi.org/10.3389/fcvm.2021.704281