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January 16, 1978, Vol 239, No. 3 >
ARTICLE | January 16, 1978

Cardiovascular Effects of Tricyclic and Tetracyclic Antidepressants FREE

Dieter Burckhardt, MD; Ernst Raeder, MD; Verena Müller, MD; Peter Imhof, MD; Hans Neubauer, MD
[+] Author Affiliations

Reprint requests to Medical University Poliklinik, Hebelstrasse 1, CH-4056 Basel, Switzerland (Dr Burckhardt).


JAMA. 1978;239(3):213-216. doi:10.1001/jama.1978.03280300045019
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References

Cardiovascular effects of therapeutic doses of tricyclic or tetracyclic antidepressants (TCA) were examined in 66 patients. After three weeks of therapy, heart rate and PR interval were increased (P<.02, P<.05), while prolongation of the QTc time and the QRS interval did not reach significant levels. We observed significant flattening of T waves (P<.05), which was not associated with changes in the serum potassium level. These changes were reversible after treatment was discontinued. When therapy was maintained for 13 months, only the heart rate continued to be increased, whereas all other ECG values had returned to normal. The TCA therapy led to a significant prolongation of the preejection period (P<.01) and slight shortening of the left ventricular ejection time, indicating a decrease in myocardial contractility. There was no difference of effects on the values studied between tricyclic and tetracyclic antidepressants.

(JAMA 239:213-216, 1978)

REFERENCES

1 +
 Adverse reactions to the tricyclic-antidepressant drugs, Report from Boston Collaborative Drug Surveillance Program . Lancet 1:529-553, 1972;.
2 +
Alexander CS, Nino A:  Cardiovascular complications in young patients taking psychotropic drugs . Am Heart J 78:757-769, 1969;.
3 +
Moccetti T, Lichtlen P, Albert H, et al:  Kardiotoxizität der trizyklischen Antidepressiva . Schweiz Med Wochenschr 101:1-10, 1971;.
4 +
Sloman L:  Myocardial infarction during imipramine treatment of depression . Can Med Assoc J 82:20-22, 1960;.
5 +
Marshall LJ, Green VA:  Propranolol and diazepam for imipramine poisoning . Lancet 2:1249, 1968;.
6 +
Stannard M, Caplan HL:  Cardiac arrest due to imipramine hydrochloride . Med J Aust 54:22-24, 1967;.
7 +
Raisfeld IH:  Cardiovascular complications of antidepressant therapy . Am Heart J 83:129-133, 1972;.
8 +
Larcan AM, Calamai M, Houplon M, et al: Coeur et toxiques . Paris, Masson & Cie, 1969;, p 137.
9 +
Jefferson JW:  Hypotension from drugs: Incidence, peril, prevention . Dis Nerv Syst 35:66-71, 1974;.
10 +
Muller OF, Goodman N, Bellet S:  The hypotensive effect of imipramine hydrochloride in patients with cardiovascular disease . Clin Pharmacol Ther 2:300-307, 1961;.
11 +
Weissler AM, Harris WS, Schoenfeld CD:  Systolic time intervals in heart failure in man . Circulation 37:149-159, 1968;.
12 +
Jefferson JW:  A review of the cardiovascular effects and toxicity of tricyclic antidepressants . Psychosom Med 37:160-179, 1975;.
13 +
Rasmussen EB, Kristjansen P:  ECG changes during amitriptyline treatment . Am J Psychiatry 119:781-782, 1963;.
14 +
Crane GE:  Cardiac toxicity and psychotropic drugs . Dis Nerv Syst 31:534-539, 1970;.
15 +
Petit JM, Spiker DG, Ruwitch JF, et al:  Tricyclic antidepressant plasma levels and adverse effects after overdose . Clin Pharmacol Ther 21:47-51, 1977;.
16 +
Richardson HL, Graupner KE, Richardson ME:  Intramyocardial lesions in patients dying suddenly and unexpectedly . JAMA 195:254-260, 1966;.
17 +
Moir D, Dingwall-Fordyce I, Weir RD:  Medicines evaluation and monitoring group . Eur J Clin Pharmacol 6:98-101, 1973;.
18 +
Freyschuss U, Sjoquist F, Tuck D:  Circulatory effects in man of nortriptyline, a tricyclic antidepressant drug . Pharmacol Clin 2:68-71, 1970;.
19 +
Robinson DS, Barker E:  Tricyclic antidepressive cardiotoxicity . JAMA 236:2089-2090, 1976;.
20 +
Coull DC, Dingwall-Fordyce I, Crooks J, et al:  Amitriptyline and cardiac disease . Lancet 2:590-591, 1970;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
 Adverse reactions to the tricyclic-antidepressant drugs, Report from Boston Collaborative Drug Surveillance Program . Lancet 1:529-553, 1972;.
2 +
Alexander CS, Nino A:  Cardiovascular complications in young patients taking psychotropic drugs . Am Heart J 78:757-769, 1969;.
3 +
Moccetti T, Lichtlen P, Albert H, et al:  Kardiotoxizität der trizyklischen Antidepressiva . Schweiz Med Wochenschr 101:1-10, 1971;.
4 +
Sloman L:  Myocardial infarction during imipramine treatment of depression . Can Med Assoc J 82:20-22, 1960;.
5 +
Marshall LJ, Green VA:  Propranolol and diazepam for imipramine poisoning . Lancet 2:1249, 1968;.
6 +
Stannard M, Caplan HL:  Cardiac arrest due to imipramine hydrochloride . Med J Aust 54:22-24, 1967;.
7 +
Raisfeld IH:  Cardiovascular complications of antidepressant therapy . Am Heart J 83:129-133, 1972;.
8 +
Larcan AM, Calamai M, Houplon M, et al: Coeur et toxiques . Paris, Masson & Cie, 1969;, p 137.
9 +
Jefferson JW:  Hypotension from drugs: Incidence, peril, prevention . Dis Nerv Syst 35:66-71, 1974;.
10 +
Muller OF, Goodman N, Bellet S:  The hypotensive effect of imipramine hydrochloride in patients with cardiovascular disease . Clin Pharmacol Ther 2:300-307, 1961;.
11 +
Weissler AM, Harris WS, Schoenfeld CD:  Systolic time intervals in heart failure in man . Circulation 37:149-159, 1968;.
12 +
Jefferson JW:  A review of the cardiovascular effects and toxicity of tricyclic antidepressants . Psychosom Med 37:160-179, 1975;.
13 +
Rasmussen EB, Kristjansen P:  ECG changes during amitriptyline treatment . Am J Psychiatry 119:781-782, 1963;.
14 +
Crane GE:  Cardiac toxicity and psychotropic drugs . Dis Nerv Syst 31:534-539, 1970;.
15 +
Petit JM, Spiker DG, Ruwitch JF, et al:  Tricyclic antidepressant plasma levels and adverse effects after overdose . Clin Pharmacol Ther 21:47-51, 1977;.
16 +
Richardson HL, Graupner KE, Richardson ME:  Intramyocardial lesions in patients dying suddenly and unexpectedly . JAMA 195:254-260, 1966;.
17 +
Moir D, Dingwall-Fordyce I, Weir RD:  Medicines evaluation and monitoring group . Eur J Clin Pharmacol 6:98-101, 1973;.
18 +
Freyschuss U, Sjoquist F, Tuck D:  Circulatory effects in man of nortriptyline, a tricyclic antidepressant drug . Pharmacol Clin 2:68-71, 1970;.
19 +
Robinson DS, Barker E:  Tricyclic antidepressive cardiotoxicity . JAMA 236:2089-2090, 1976;.
20 +
Coull DC, Dingwall-Fordyce I, Crooks J, et al:  Amitriptyline and cardiac disease . Lancet 2:590-591, 1970;.

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