Roose S P, Dalack G W, Glassman A H, Woodring S, Walsh B T, Giardina E G
New York State Psychiatric Institute, New York.
Am J Psychiatry. 1991 Apr;148(4):512-6. doi: 10.1176/ajp.148.4.512.
The cardiovascular effects of therapeutic plasma levels of tricyclic antidepressants in depressed patients with and without preexisting cardiac disease have been well characterized and include orthostatic hypotension and conduction delay. Bupropion, structurally unrelated to tricyclic antidepressants, is relatively free of cardiac side effects in depressed patients without cardiac disease. However, it is unknown whether bupropion is safe for depressed patients with preexisting heart disease, so the authors studied the cardiovascular effects of bupropion in such patients.
The subjects were 36 inpatients with DSM-III major depression and preexisting left ventricular impairment (N = 15), ventricular arrhythmias (N = 15), and/or conduction disease (N = 21). The patients continued their cardiac drug regimens and received bupropion for 3 weeks (mean +/- SD dose = 442 +/- 47 mg/day). Cardiovascular functioning was measured by pulse, blood pressure, high-speed ECG, 24-hour portable ECG, and radionuclide angiography.
Although bupropion caused a rise in supine blood pressure, it did not cause significant conduction complications, did not exacerbate ventricular arrhythmias, had a low rate of orthostatic hypotension, and had no effect on pulse rate. However, bupropion treatment was discontinued for 14% of the patients because of adverse effects, including exacerbation of baseline hypertension in two patients.
The cardiovascular profile of bupropion may make this drug a useful agent in the treatment of the depressed patient with preexisting cardiovascular disease. Further studies, with longer durations of bupropion treatment and more subjects, are needed to confirm these findings.
三环类抗抑郁药在治疗剂量下对伴有或不伴有心脏病史的抑郁症患者的心血管影响已得到充分研究，包括体位性低血压和传导延迟。安非他酮在结构上与三环类抗抑郁药无关，在无心脏病的抑郁症患者中相对没有心脏副作用。然而，安非他酮对已有心脏病的抑郁症患者是否安全尚不清楚，因此作者研究了安非他酮在此类患者中的心血管影响。
研究对象为36例符合《精神疾病诊断与统计手册》第三版（DSM-III）标准的重度抑郁症住院患者，他们存在左心室功能损害（n = 15）、室性心律失常（n = 15）和/或传导疾病（n = 21）。患者继续服用心脏疾病治疗药物，并接受安非他酮治疗3周（平均±标准差剂量 = 442±47毫克/天）。通过脉搏、血压、高速心电图、24小时便携式心电图和放射性核素血管造影来测量心血管功能。
虽然安非他酮导致仰卧位血压升高，但未引起明显的传导并发症，未加重室性心律失常，体位性低血压发生率低，且对脉搏率无影响。然而，14%的患者因不良反应而停用安非他酮，其中包括两名患者的基线高血压加重。
安非他酮的心血管特征可能使其成为治疗已有心血管疾病的抑郁症患者的有用药物。需要进一步开展研究，延长安非他酮治疗时间并增加受试者数量，以证实这些发现。
