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Antidepressants and heart disease.

1984; BMJ; Volume: 289; Issue: 6436 Linguagem: Inglês

10.1136/bmj.289.6436.1

0959-8138

M.L'E. Orme,

Tryptophan and brain disorders

Antidepressants and heart diseaseWhen taken in overdosage tricyclic antidepressant drugs may be cardiotoxic.I 2 The most common findings are tachycardia and hypotension, but cardiac arrhythmias and abnormalities in cardiac conduction are also important.This reputation of tricyclic antidepressants for cardiotoxicity was enhanced by a series of papers from Aberdeen linking the therapeutic use of amitriptyline with sudden cardiac death, especially in patients with pre-existing cardiac disease.3-5Though the Boston Collaborative Drug Surveillance Program could find no evidence of such an association,6 the problem has continued to trouble physicians and has led to the introduction of antidepressants that may be less cardiotoxic than amitriptyline.Different antidepressants have different effects on the heart.All currently available tricyclic antidepressant drugs have anticholinergic (atropine like) activity, which causes tachycardia and decreases conduction time through the atrio- ventricular node.In addition, the tricyclic antidepressant drugs have a quinidine like activity on the myocardium-and this may delay atrioventricular conduction.The net effect on the electrocardiogram in most studies is to prolong the PR and QT intervals.7A further effect of tricyclic antidepressants How can the prescribing physician steer a sensible course?