Relative Safety of Single Versus Divided Dose Imipramine in Adolescent Major Depression

Ryan, Neal D.; Puig-Antich, Joaquim; Cooper, Thomas B.; Rabinovich, Harris; Ambrosini, Paul J.; Fried, Jane; Davies, Mark; Torres, Debbie; Suckow, Raymond F.

doi:10.1097/00004583-198705000-00021

Cited by 24 publications

(3 citation statements)

References 9 publications

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“…Adults show more than a 30-fold difference in plasma levels at a given dose (Sjoqvist and Bertilsson, 1984), and similarly wide variations in plasma level are seen in children and adolescents (Preskorn etal. 1983;Ryan et al 1987). DOSAGE AND REGIMEN Enuresis.…”

Section: Pharmacokinetics In Children and Adolescentsmentioning

confidence: 99%

“…Large increases in conduction slowing (PR > 0.21, QRS > 0.12) can lead to potentially dangerous cardiac function. Although children generally do not have the cardiac disorders seen in older adult patients, the immature cardiac system is more susceptible to the cardiotoxic effects of tricyclic antidepressants (Ryan et al 1987). Induction ofpsychosis.…”

Section: Uncommon But Potentially Serious Adverse Effectsmentioning

confidence: 99%

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Heterocyclic Antidepressants in Children and Adolescents

Ryan¹

1990

Journal of Child and Adolescent Psychopharmacology

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Over 40 double-blind studies have demonstrated the efficacy of tricyclic antidepressants, but the therapeutic effects may wear off in certain patients after several weeks. Unlike the tricyclic treatment of other psychiatric disorders, the antienuretic effect is seen with no delay after start of treatment. Desipramine and imipramine have similar efficacy. Imipramine has more side effects, and low cost is its only advantage. Desipramine should probably be reserved for cases involving both dayand nighttime enuresis, or for cases of nocturnal enuresis that have not responded to standard conservative measures (Shaffer 1985).

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Section: Pharmacokinetics In Children and Adolescentsmentioning

confidence: 99%

Section: Uncommon But Potentially Serious Adverse Effectsmentioning

confidence: 99%

Heterocyclic Antidepressants in Children and Adolescents

Ryan¹

1990

Journal of Child and Adolescent Psychopharmacology

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“…However, more severe conduction slowing may result in serious cardiac dysfunctions, including heart block or arrhythmia (Ryan 1990). Since children may be at greater risk than adults for the cardiotoxic effects of TCAs (Ryan et al 1987), there is a general belief that the cardiotoxicity of TCAs may be the crucial adverse effect that is responsible for these three cases of sudden death.…”

Section: Speculations On Mechanismsmentioning

confidence: 99%

Sudden Death and Tricyclic Antidepressants: Clinical Considerations for Children

Popper¹,

Elliott²

1990

Journal of Child and Adolescent Psychopharmacology

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The sudden collapse and death in three prepubertal children during routine treatment with desipramine was recently reported in brief statements. Insufficient clinical information is available to infer a cause-and-effect relationship between the therapeutic use of desipramine and sudden death in these children. Speculatively, a variety of possible mechanisms could account for sudden death in children receiving treatment with tricyclic antidepressants: a cardiac event, an increase or decrease in blood pressure, an increase in pulse, a seizure (with complications), or heat stroke. The extent of medical monitoring in the three cases is not clear, leaving unresolved whether a change in standard monitoring procedures is indicated. The total number of children who have received desipramine treatment is not known, so it is not possible to specify the incidence of this putative adverse effect. It is clear that the incidence of death from accidental overdose is substantially higher. Given the current available level of knowledge about these cases, no clinical recommendations are offered concerning when to avoid or to use desipramine; however, certain clinical considerations regarding the use of antidepressants in children are raised and discussed.

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