Ecg Changes During Amitriptyline Treatment

Rasmussen, E. Boje; Kristjansen, P.

doi:10.1176/ajp.119.8.781

Cited by 42 publications

(10 citation statements)

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“…Kristjansen (1961) first reported minor ST-T segment changes on the electrocardiogram (ECG) occurring in depressed patients taking imipramine following exercise. Since then, various ECG and haemodynamic changes have been described both in therapeutic dosage and after overdosage of TADs (Rasmussen and Kristjansen, 1963;Thorstrand, 1974Thorstrand, , 1976Jefferson, 1975;Vohra, Burrows and Sioman, 1975). Sudden death has also been reported in patients with heart disease who received amitriptyline (Coull et al, 1970;Moir et al, 1972).…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular effects of amitriptyline, mianserin, zimelidine and nomifensine in depressed patients

Burgess

Montgomery

Wadsworth

et al. 1979

Postgraduate Medical Journal

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SummaryThe cardiac effects of amitriptyline, mianserin, zimelidine and nomifensine on the systolic time intervals (STI) and on the high speed surface ECG have been studied in depressed patients. Amitriptyline increased pre-ejection period (PEP) index and the PEP/left ventricular ejection time (LVET) ratio of the STI (P <0.05 and P <0.02). It also increased heart rate significantly (< 0.02) and tended to prolong Q-T interval. Mianserin shortened QS2I (P <0.05) and LVET (P < 0-01) and prolonged PEP/LVET ratio (P <0-01). Zimelidine did not affect the STI but tended to decrease heart rate and prolong the Q-T interval. Nomifensine decreased T wave height. These findings indicate that amitriptyline decreases cardiac contractility and confirm the quinidine-like action of the tricyclic antidepressants. The changes brought about by mianserin are probably due to effects on the peripheral circulation rather than a direct action on the heart.

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Section: Introductionmentioning

confidence: 99%

Cardiovascular effects of amitriptyline, mianserin, zimelidine and nomifensine in depressed patients

Burgess

Montgomery

Wadsworth

et al. 1979

Postgraduate Medical Journal

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“…These have been reported to include sinus tachycardia, bradycardia, asystole, conduction defects and ventricular and supraventricular dysrhythmias (Rasmussen & Kristiansen, 1963;Thorstrand, 1974;1976;Jefferson, 1975;Vohra, Burrows & Sloman, 1975). Tricyclic antidepressants are also known to increase the width of the QRS complex (Thorstrand, 1976;Bigger, Giar-dina, Perel, Kantor & Glassman, 1977) and to lengthen the P-R interval (Burrows, Vohra, Hunt, Sloman, Scoggins & Davies, 1976;Ziegler, Co & Biggs, 1977).…”

Section: Introductionmentioning

confidence: 99%

THE RELATIVE TOXICITY OF AMITRIPTYLINE, IMIPRAMINE, MAPROTILINE AND MIANSERIN IN RABBITSin vivo

Hughes

Radwan

1979

British Journal of Pharmacology

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1 Conscious or barbiturate-anaesthetized rabbits were slowly infused intravenously with solutions of amitriptyline, imipramine, maprotiline or mianserin, usually until death occurred. 2 Amitriptyline produced death at the lowest dose, imipramine and maprotiline were intermediate while much higher doses of mianserin were required. 3 Convulsions were induced by the antidepressants in all conscious rabbits and the order of potency of the drugs in producing this effect was amitriptyline > imipramine > maprotiline >> mianserin. 4 All four drugs produced a reduction in heart rate and blood pressure in the anaesthetized rabbits and the order of potency in this respect was amitriptyline > imipramine > maprotiline > mianserin. 5 All four drugs produced significant changes in the ECG compared with control rabbits. The P-R interval was lengthened (potency order amitriptyline > imipramine > maprotiline >> mianserin) and the QRS complex was widened (potency order amitriptyline > imipramine > maprotiline >> mianserin).7 It is concluded that all four drugs show the toxic effects classically associated with tricyclic antidepressants but the relative toxicity amongst these agents varies considerably and is in the order amitriptyline > imipramine > maprotiline >> mianserin.

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“…The toxicity of the TCAs has been well known since their introduction. Studies dating from the early 1960s have shown that the TCAs are highly cardiotoxic, even in moderate overdosage [19][20][21][22][23][24][25][26][27][28][29][30]. Major depression is highly correlated with a predictable risk of suicide and suicide attempt, frequently involving drug overdose [24][31][32][33].…”

Section: The Older and Newer Antidepressants Comparedmentioning

confidence: 99%

“…Major depression is highly correlated with a predictable risk of suicide and suicide attempt, frequently involving drug overdose [24][31][32][33]. Concern has also been expressed in medical journals since the early 1970s about the use of TCAs with cardiac patients [19][20][21][22][23][24][25][26][27][28]. A meta‐analysis of 67 published, randomised, controlled clinical trials comparing SSRIs and TCAs demonstrated that SSRIs have a significant and clinically important advantage over TCAs with respect to tolerability, whereas efficacy is similar.…”

Section: The Older and Newer Antidepressants Comparedmentioning

confidence: 99%

Liability in prescribing choice: the example of the antidepressants

Beerworth¹,

Tiller

1998

Aust N Z J Psychiatry

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There needs to be compelling reasons for prescribing medicines with a greater likelihood of adverse outcomes such as the older antidepressants (e.g. tricyclics) rather than the newer antidepressants such as RIMAs, SSRIs, SNRIs and 5HT2 receptor antagonists. The higher likelihood of an adverse outcome of treatment where an older antidepressant has been prescribed raises the potential for professional negligence claims to be brought against medical practitioners who prescribe such medicines for reasons other than established medical need.

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Ecg Changes During Amitriptyline Treatment

Cited by 42 publications

References 0 publications

Cardiovascular effects of amitriptyline, mianserin, zimelidine and nomifensine in depressed patients

Cardiovascular effects of amitriptyline, mianserin, zimelidine and nomifensine in depressed patients

THE RELATIVE TOXICITY OF AMITRIPTYLINE, IMIPRAMINE, MAPROTILINE AND MIANSERIN IN RABBITSin vivo

Liability in prescribing choice: the example of the antidepressants

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