Cardiovascular effects of tricyclic antidepressants in depressed patients with chronic heart disease.
Twenty-four depressed patients with heart disease were treated for four weeks in a double-blind trial of imipramine, doxepin, or placebo to assess the effects of tricyclic antidepressants on ventricular function and rhythm. The tricyclic antidepressants had no effect on left ventricular ejection fraction at rest or during maximal exercise, as measured by radionuclide ventriculograms obtained before and after treatment. Premature ventricular contractions were reduced by imipramine but were not consistently changed by doxepin or placebo. Treatment with imipramine and doxepin, but not placebo, was associated with significant improvement (P less than 0.001) in standard ratings of depression. Our findings underscore the need for a reappraisal of the cardiovascular risks of tricyclic antidepressants and suggest that in the absence of severe impairment of myocardial performance, depressed patients with preexisting heart disease can be effectively treated with these agents without an adverse effect on ventricular rhythm or hemodynamic function.
D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001794:Blood Pressure / Q000187:drug effects; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy*; D004316:Doxepin / Q000494:pharmacology / Q000627:therapeutic use; D004562:Electrocardiography; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D007099:Imipramine / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects
D000929:Antidepressive Agents, Tricyclic; D004316:Doxepin; D007099:Imipramine