Tricyclic Antidepressants in Depressed Patients With Cardiac Conduction Disease

Evidence-Based Pharmacologic Interventions for Geriatric Depression

“…SSRIs are associated with higher rates of nausea, loss of appetite, and sexual dysfunction, but they have less anticholinergic and cardiovascular side effects compared with TCAs [45]. Patients with pre-existing bundle branch block who are treated with TCAs may develop second degree block [72]. The choice among different SSRIs may be guided by the absence of drug interactions, simplicity of dosing, and side-effect profile.…”

Falls prevention in primary care

“…16,17 Tricyclic antidepressants can cause a fall in standing blood pressure which can lead to dizziness and fainting. 18 When serotonin reuptake inhibitor antidepressants such as fluoxetine were introduced, they were considered safer. 19 Unfortunately a study of over 2000 people living in Tennessee nursing homes proved that there was little difference in fall rates in those treated with tricyclics and newer antidepressants.…”

Psychotropic medication and the heart

“…Tricyclic antidepressants are more likely to produce higher degrees of heart block in patients with pre-existing bundle branch block (QRS >12 ms) rather than first-degree block (PR >200 ms) (Roose et al, 1987) and they should therefore be avoided in all cases of conduction disease beyond first-degree block. None the less, tricyclics are best avoided in patients with any degree of pre-existing conduction delay, because safer alternatives are available with SSRIs.…”