Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1979 Oct;55(648):704–708. doi: 10.1136/pgmj.55.648.704

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

C D Burgess, S Montgomery, J Wadsworth, P Turner
PMCID: PMC2425751  PMID: 537956

Abstract

The 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 less than 0.05 and P less than 0.02). It also increased heart rate significantly (less than 0.02) and tended to prolong Q-T interval. Mianserin shortened QS2I (P less than 0.05) and LVET (P less than 0.01) and prolonged PEP/LVET ratio (P less than 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.

Full text

PDF
704

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Axelrod J., Weinshilboum R. Catecholamines. N Engl J Med. 1972 Aug 3;287(5):237–242. doi: 10.1056/NEJM197208032870508. [DOI] [PubMed] [Google Scholar]
  2. Bigger J. T., Giardina E. G., Perel J. M., Kantor S. J., Glassman A. H. Cardiac antiarrhythmic effect of imipramine hydrochloride. N Engl J Med. 1977 Jan 27;296(4):206–208. doi: 10.1056/NEJM197701272960407. [DOI] [PubMed] [Google Scholar]
  3. Burckhardt D., Raeder E., Müller V., Imhof P., Neubauer H. Cardiovascular effects of tricyclic and tetracyclic antidepressants. JAMA. 1978 Jan 16;239(3):213–216. [PubMed] [Google Scholar]
  4. Burrows G. D., Vohra J., Hunt D., Sloman J. G., Scoggins B. A., Davies B. Cardiac effects of different tricyclic antidepressant drugs. Br J Psychiatry. 1976 Oct;129:335–341. doi: 10.1192/bjp.129.4.335. [DOI] [PubMed] [Google Scholar]
  5. Carr A. C., Hobson R. P. High serum concentrations of antidepressants in elderly patients. Br Med J. 1977 Oct 29;2(6095):1151–1151. doi: 10.1136/bmj.2.6095.1151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cassano G. B., Sjöstrand S. E., Hansson E. Distribution and fate of C-14-amitriptyline in mice and rats. Psychopharmacologia. 1965 Jun 1;8(1):1–11. doi: 10.1007/BF00405356. [DOI] [PubMed] [Google Scholar]
  7. Coppen A., Gupta R., Montgomery S., Ghose K., Bailey J., Burns B., de Ridder J. J. Mianserin hydrochloride: a novel antidepressant. Br J Psychiatry. 1976 Oct;129:342–345. doi: 10.1192/bjp.129.4.342. [DOI] [PubMed] [Google Scholar]
  8. Coull D. C., Crooks J., Dingwall-Fordyce I., Scott A. M., Wier R. D. Amitriptyline and cardiac disease. Risk of sudden death identified by monitoring system. Lancet. 1970 Sep 19;2(7673):590–591. doi: 10.1016/s0140-6736(70)90169-8. [DOI] [PubMed] [Google Scholar]
  9. Feighner J. P., Robins E., Guze S. B., Woodruff R. A., Jr, Winokur G., Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972 Jan;26(1):57–63. doi: 10.1001/archpsyc.1972.01750190059011. [DOI] [PubMed] [Google Scholar]
  10. Ghose K., Coppen A., Turner P. Autonomic actions and interactions of mianserin hydrochloride (Org. GB 94) and amitriptyline in patients with depressive illness. Psychopharmacology (Berl) 1976 Sep 17;49(2):201–204. doi: 10.1007/BF00427291. [DOI] [PubMed] [Google Scholar]
  11. Jefferson J. W. A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosom Med. 1975 Mar-Apr;37(2):160–179. doi: 10.1097/00006842-197503000-00006. [DOI] [PubMed] [Google Scholar]
  12. Lewis R. P., Rittogers S. E., Froester W. F., Boudoulas H. A critical review of the systolic time intervals. Circulation. 1977 Aug;56(2):146–158. doi: 10.1161/01.cir.56.2.146. [DOI] [PubMed] [Google Scholar]
  13. Moir D. C., Cornwell W. B., Dingwall-Fordyce I., Crooks J., O'Malley K., Turnbull M. J., Weir R. D. Cardiotoxicity of amitriptyline. Lancet. 1972 Sep 16;2(7777):561–564. doi: 10.1016/s0140-6736(72)91958-7. [DOI] [PubMed] [Google Scholar]
  14. Müller V., Burckhardt D. Die Wirkung tri- und tetrazyklischer Antidepressiva auf Herz und Kreislauf. Schweiz Med Wochenschr. 1974 Dec 21;104(51):1911–1913. [PubMed] [Google Scholar]
  15. Saxena P. R., van Houwelingen P., Bonta I. L. The effects of mianserin hydrochloride on the vascular responses evoked by 5-hydroxytryptamine and related vasoactive substances. Eur J Pharmacol. 1971;13(3):295–305. doi: 10.1016/0014-2999(71)90218-4. [DOI] [PubMed] [Google Scholar]
  16. Schacht U., Heptner W. Effect of nomifensine (HOE 984), a new antidepressant, on uptake of noradrenaline and serotonin and on release of noradrenaline in rat brain synaptosomes. Biochem Pharmacol. 1974 Dec 15;23(24):3413–3422. doi: 10.1016/0006-2952(74)90344-x. [DOI] [PubMed] [Google Scholar]
  17. Siwers B., Ringberger V. A., Tuck J. R., Sjöqvist F. Initial clinical trial based on biochemical methodology of zimelidine (a serotonin uptake inhibitor) in depressed patients. Clin Pharmacol Ther. 1977 Feb;21(2):194–200. doi: 10.1002/cpt1977212194. [DOI] [PubMed] [Google Scholar]
  18. Thorstrand C. Cardiovascular effects of poisoning with tricyclic antidepressants. Acta Med Scand. 1974 Jun;195(6):505–514. doi: 10.1111/j.0954-6820.1974.tb08179.x. [DOI] [PubMed] [Google Scholar]
  19. Thorstrand C. Clinical features in poisonings by tricyclic antidepressants with special reference to the ECG. Acta Med Scand. 1976;199(5):337–344. doi: 10.1111/j.0954-6820.1976.tb06745.x. [DOI] [PubMed] [Google Scholar]
  20. Vohra J., Burrows G. D., Sloman G. Assessment of cardiovascular side effects of therapeutic doses of tricyclic anti-depressant drugs. Aust N Z J Med. 1975 Feb;5(1):7–11. doi: 10.1111/j.1445-5994.1975.tb03247.x. [DOI] [PubMed] [Google Scholar]
  21. Weissler A. M. Current concepts in cardiology. Systolic-time intervals. N Engl J Med. 1977 Feb 10;296(6):321–324. doi: 10.1056/NEJM197702102960607. [DOI] [PubMed] [Google Scholar]
  22. Weissler A. M., Harris W. S., Schoenfeld C. D. Bedside technics for the evaluation of ventricular function in man. Am J Cardiol. 1969 Apr;23(4):577–583. doi: 10.1016/0002-9149(69)90012-5. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES