Cardiovascular effects of antidepressants

  • Graham D. Burrows
  • Trevor Norman
  • Ian Hughes


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.


Electrocardiographic Change Right Bundle Branch Block Cardiovascular Side Effect Steady State Plasma Level Boston Collaborative Drug Surveillance Program 
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Copyright information

© The contributors 1981

Authors and Affiliations

  • Graham D. Burrows
    • 1
  • Trevor Norman
    • 1
  • Ian Hughes
    • 2
  1. 1.Department of PsychiatryUniversity of MelbourneParkvilleAustralia
  2. 2.Department of Pharmacology, Worsley Medical and Dental BuildingUniversity of LeedsLeedsUK

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