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Cardiovascular effects of antidepressants

  • Chapter
Clinical Pharmacology in Psychiatry

Abstract

A great variety of symptoms have been reported after the ingestion of an overdose of a tricyclic antidepressant (TCA). These include disorientation, ataxia, vomiting, coma, convulsions, ECG changes and dysrhythmias (Hamilton and Mahapatre, 1972). As some of the TCA appear to show an affinity for myocardial tissue (Jefferson, 1975; Elonen et al., 1975; Bianchetti et al., 1977), it is not surprising that a large proportion of individuals experiencing overdose of these drugs show signs of cardiotoxicity. This is compelling evidence for a serious cardiotoxicity in overdose; even at therapeutic dose levels there is strong evidence to show that changes in cardiac parameters may occur with nortriptyline (NT) (Taylor and Braith-waite, 1978; Burrows et al., 1976), imipramine (IMI) (Kristiansen, 1961; Bigger et al., 1977), clomipramine (CI) (Singh, 1972) and amitriptyline (AMI) (Smith and Rusbatch, 1967; Scollins et al., 1972), although these changes are not apparent in all patients (Jefferson, 1975; Vohra et al., 1975a,b,c). Using surface ECG recording and in other studies using His bundle electrocardiography (HBE), Burrows et al. (1976) found that intracardiac conduction was prolonged in patients taking therapeutic doses of TCA, and Taylor and Braithwaite (1978), using systolic time interval measurements, found changes indicating that a deterioration in cardiac function occurred with NT which was correlated with the plasma level.

This paper has been modified from the chapter entitle ‘Cardiotoxicity of antidepressants: experimental background’ in Stress and the Heart, 2nd edn (ed. D. Wheatley), Raven Press, New York.

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Authors and Affiliations

  1. Department of Psychiatry, University of Melbourne, Parkville, 3052, Victoria, Australia

    Graham D. Burrows & Trevor Norman

  2. Department of Pharmacology, Worsley Medical and Dental Building, University of Leeds, Leeds, UK

    Ian Hughes

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  1. National Institute of Mental Health, Parklawn Building, Room 9C-09, 5600 Fishers Lane, Rockville, Maryland, 20857, USA

    Earl Usdin

  2. Department of Pharmacology, Institute of Medical Biology, University of Tromsø, N-9000, Tromsø, Norway

    Svein G. Dahl

  3. Department of Pharmacology, Odense University, J. B. Winslöwsvej 19, DK-5000, Odense C, Denmark

    Lars F. Gram

  4. Department of Clinical Psychiatry, Institute of Community Medicine, University of Tromsø, N-9000, Tromsø, Norway

    Odd Lingjærde

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Burrows, G.D., Norman, T., Hughes, I. (1981). Cardiovascular effects of antidepressants. In: Usdin, E., Dahl, S.G., Gram, L.F., Lingjærde, O. (eds) Clinical Pharmacology in Psychiatry. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-05929-4_29

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