We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

The Safety of Tricyclic Antidepressants in Cardiac Patients Risk-Benefit Reconsidered

Alexander H. Glassman, MD; Steven P. Roose, MD; J. Thomas Bigger Jr, MD
JAMA. 1993;269(20):2673-2675. doi:10.1001/jama.1993.03500200087039.
Text Size: A A A
Published online


IN 1977, we first reported the antiarrhythmic effect of imipramine hydrochloride.1 Prior to that time, physicians generally believed that the tricyclic antidepressants (TCAs) caused arrhythmia. That belief stemmed from the propensity of overdoses of these drugs to provoke arrhythmias.2 However, it subsequently became apparent, both from our studies3-6 and the work of others,7 that at plasma concentrations therapeutic for depression,8 TCAs suppress arrhythmias, and their cardiac effects closely resemble those of class I antiarrhythmic drugs.9,10 Until recently, it was our belief that depressed patients with preexisting arrhythmias would benefit from the antiarrhythmic effect of TCAs.11,12 Unfortunately, recent studies indicate that this opinion may need to be revised.

Ventricular premature depolarizations (VPDs) are a well-documented risk factor for sudden death after myocardial infarction (MI)13,14 and the assumption had been that drugs that suppress VPDs would reduce this associated mortality. However, in 1983, Furberg


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.