Psychopharmacology

, Volume 87, Issue 2, pp 212–215 | Cite as

Cardiovascular effects of amitriptyline in the treatment of elderly depressed patients

  • P. Christensen
  • H. Y. Thomsen
  • O. L. Pedersen
  • P. Thayssen
  • H. Oxhøj
  • P. Kragh-Sørensen
  • L. F. Gram
Original Investigations

Abstract

Thirteen elderly depressed patients (age 60–82 years) were treated for 5 weeks with a fixed dose of amitriptyline 100 mg (sustained release preparation). In all patients the sum of concentrations of amitriptyline and nortriptyline exceeded 130 μg/l, which is the recommended plasma level. Cardiovascular side effects were recorded by monitoring heart rate, blood pressure, standard ECG and systolic time intervals. During treatment, a transient increase in the supine heart rate was observed without significant changes in the supine blood pressure. The orthostatic drop in blood pressure was markedly increased during treatment without a compensatory increase in heart rate, and these changes remained significant during the whole investigational period. PQ and QRS were significantly increased during treatment, and significant changes in the systolic time intervals were found indicating impairment of myocardial conduction and contractility. In three patients medication was discontinued due to cardiovascular side effects.

Key words

Elderly patients Antidepressive treatment Orthostatic blood pressure Systolic time intervals 

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References

  1. Åsberg M, Cronholm B, Sjöqvist F, Tuck D (1970) Correlation of subjective side effects with plasma concentrations of nortriptyline. Br Med J 4:18–21Google Scholar
  2. Bertram U, Kragh-Sørensen P, Rafaelsen OJ, Larsen N-E (1979) Saliva secretion following long-term antidepressant treatment with nortriptyline controlled by plasma levels. Scand J Dent Res 87:58–64Google Scholar
  3. Burckhardt D, Raeder E, Müller V, Imhof P, Neubauer H (1978) Cardiovascular effects of tricyclic and tetracyclic antidepressants. JAMA 239:213–216Google Scholar
  4. Burgess CD, Montgomery S, Wadsworth J, Turner P (1979) Cardiovascular effects of amitriptyline, mianserin, zimelidine and nomifensine in depressed patients. Postgrad Med J 55:704–708Google Scholar
  5. Fleisch JH (1981) Age-related decrease in beta-adrenoceptor activity of the cardiovascular system. TIPS 2:337–339Google Scholar
  6. Glassman AH, Bigger JT (1981) Cardiovascular effects of therapeutic doses of tricyclic antidepressants. Arch Gen Psychiatr 38:815–820Google Scholar
  7. Gram LF, Søndergård I, Christiansen J, Petersen GO, Bech P, Reisby N, Ibsen I, Ortmann J, Nagy A, Dencker SJ, Jacobsen O, Krautwald O (1977) Steady-state kinetics of imipramine in patients. Psychopharmacology 54:255–261Google Scholar
  8. Gram LF (1983) Antidepressants: Receptors, pharmacokinetics and clinical effects. In: Burrows GD, Norman TR, Davis B (eds). Drugs in psychiatry, volume I, Antidepressants. Elsevier/North-Holland Biomedial Press BV, Amsterdam 1983, pp 81–96Google Scholar
  9. Gurney C, Roth M, Garside RF, Kerr TA, Schapira K (1972) Studies in the classification of affective disorders. The relationship between anxiety states and depressive illnesses. J Psychiatr 121:162–166Google Scholar
  10. Hamilton M (1967) Development of a rating scale for primary depressive illness. J Soc Clin Psychol 6:278–296Google Scholar
  11. Kragh-Sørensen P, Larsen N-E (1980) Factors influencing nortriptyline steady-state kinetics: plasma and saliva levels. Clin Pharmacol Ther 28:796–803Google Scholar
  12. Kristiansen ES (1961) Cardiac complications during treatment with imipramine (tofranil). Acta Psychiat Scand 36:427–442Google Scholar
  13. Kristjansen P, Poulsen H (1963) Grenblok som bivirkning ved amitriptylin-behandling. Ugeskr Læg 125:394–395Google Scholar
  14. Lakatta EG (1980) Age-related alterations in the cardiovascular response to adrenergic mediated stress. Fed Proc 39:3173–3177Google Scholar
  15. Møller M, Thayssen P, Kragh-Sørensen P, Pedersen OL, Kristensen CB, Bjerre M, Benjaminsen S, Gram LF (1983) Mianserin: Cardiovascular effects in elderly patients. Psychopharmacology 80:174–177Google Scholar
  16. Nagy A, Treiber L (1973) Quantitative determination of imipramine and desimipramine in human blood plasma by direct densiometry of thin-layer chromatograms. J Pharm Pharmacol 25:599–603Google Scholar
  17. Nielsen JR, Johansen T, Arentoft A, Gram LF (1983) Effects of imipramine on the orthostatic changes in blood pressure, heart rate and catecholamines. Clin Exp Pharmacol Physiol 10:497–504Google Scholar
  18. Nies A, Robinson DS, Friedman MJ, Green R, Cooper TB, Ravaris CL, Ives JO (1977) Relationship between age and tricyclic antidepressant plasma levels. Am J Psychiatry 134:790–793Google Scholar
  19. Peet M, Tienari P, Jaskari MO (1977) A comparison of the cardiac effects of mianserin and amitriptyline in man. Pharmacopsychiat Neuropsychopharmacol 10:309–312Google Scholar
  20. Raeder E, Burckhardt D, Neubauer H, Walter R, Gastpar M (1978) Long-term tri- and tetra-cyclic antidepressants, myocardial contractility and cardiac rhythm. Br Med J 2:666–667Google Scholar
  21. Rowe JW, Troen BR (1980) Sympathetic nervous system and aging in man. Endocr Rev 1:167–179Google Scholar
  22. Smith RB, Rusbatch BJ (1967) Amitriptyline and heart block. Br Med J 3:311Google Scholar
  23. Taylor JE, Braithwaite RA (1978) Cardiac effects of tricyclic antidepressant medication. Br Heart J 40:1005–1009Google Scholar
  24. Thayssen P, Bjerre M, Kragh-Sørensen P, Møller M, Pedersen OL, Kristensen CB, Gram LF (1981) Cardiovascular effects of imipramine and nortriptyline in elderly patients. Psychopharmacology 74:360–364Google Scholar
  25. Videbæk J (1979) Isometric pressure indices. Thesis, CopenhagenGoogle Scholar
  26. Weissler AM, Harris WS, Schoenfeld CD (1968) Systolic time intervals in heart failure in man. Circulation 37:149–159Google Scholar
  27. Weissler AM, Harris WS, Schoenfeld CD (1969) Bedside technics for the evaluation of ventricular function in man. Am J Cardiol 23:577–583Google Scholar
  28. Ziegler VE, Co BT, Biggs JT (1977) Electrocardiographic findings in patients undergoing amitriptyline treatment. Dis Nerv Syst 38:697–699Google Scholar

Copyright information

© Springer-Verlag 1985

Authors and Affiliations

  • P. Christensen
    • 1
    • 3
  • H. Y. Thomsen
    • 1
  • O. L. Pedersen
    • 1
  • P. Thayssen
    • 2
  • H. Oxhøj
    • 2
  • P. Kragh-Sørensen
    • 1
  • L. F. Gram
    • 3
  1. 1.Department of PsychiatryOdense UniversityOdense CDenmark
  2. 2.Department of Clinical PhysiologyOdense UniversityOdense CDenmark
  3. 3.Department of Clinical PharmacologyOdense UniversityOdense CDenmark

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