Cardiovascular Effects of Therapeutic Doses of Tricyclic Antidepressants: A Review

doi:10.1001/archpsyc.1981.01780320095011

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Vol. 38 No. 7, July 1981

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Cardiovascular Effects of Therapeutic Doses of Tricyclic Antidepressants

A Review

Alexander H. Glassman, MD; J. Thomas Bigger, Jr, MD

Arch Gen Psychiatry. 1981;38(7):815-820.

Abstract

• Overdoses of tricyclic antidepressants (TCAs) leave nodoubt that TCA drugs at high concentrations have serious cardiaceffects. It has been assumed that, to a lesser extent, theseeffects would occur at usual therapeutic concentration. Recentprospective, plasma-level-controlled studies have improved ourunderstanding of these drugs and proved these assumptions tobe inaccurate. The most common serious cardiovascular complicationof most tricyclic drugs is orthostatic hypotension. Tricyclicantidepressants are essentially free of any other serious adverseeffects in depressed patients without cardiovascular disease.In patients with preexisting bundlebranch disease, there isa risk of heart block. On the other hand, patients with ventriculararrhythmias are likely to have their arrhythmias improve withTCA therapy. Finally, therapeutic doses of TCA have little adverseeffect on left ventricular performance. As a result, TCA drugscan often be used to benefit depressed patients with overt heartdisease.

Author Affiliations

From the Department of Clinical Psychopharmacology, New York State Psychiatric Institute, New York (Dr Glassman), and the Departments of Psychiatry (Dr Glassman) and Medicine and Pharmacology (Dr Bigger), College of Physicians and Surgeons, Columbia University, New York.

Footnotes

Accepted for publication Nov 13, 1980.

Reprint requests to New York State Psychiatric Institute, 722W 168th St, New York, NY 10032 (Dr Glassman).

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