Jackson W K, Roose S P, Glassman A H
New York Psychiatric Institute, N.Y.
Psychopathology. 1987;20 Suppl 1:64-74. doi: 10.1159/000284525.
This article reviews the cardiovascular effects of the standard tricyclic antidepressant agents and the cardiovascular effects of the newer antidepressant drugs. The cardiovascular effects of the standard tricyclic agents are orthostatic hypotension, conduction delay, and a potent antiarrhythmic effect. Patients with congestive heart failure receiving cardiac medications are at greatly increased risk for orthostatic hypotension, while patients with preexisting conduction delay are at risk for heart block. Of the newer antidepressant drugs, mianserin, nomifensine, and bupropion initially appeared to be most promising in terms of cardiovascular effects, but subsequently proved to have other serious liabilities; these agents require further testing. Trazodone has emerged as the antidepressant drug with the least risk of death in overdose, and as a useful alternative to the standard tricyclic antidepressant drugs in patients with preexisting conduction disease. However, trazodone therapy has been associated with some adverse effects, and, therefore, from the data presented in this paper, it can be concluded that no drug currently available is without some cardiovascular risk.
本文综述了标准三环类抗抑郁药的心血管效应以及新型抗抑郁药的心血管效应。标准三环类药物的心血管效应包括体位性低血压、传导延迟和强效抗心律失常作用。接受心脏药物治疗的充血性心力衰竭患者发生体位性低血压的风险大大增加，而已有传导延迟的患者有发生心脏传导阻滞的风险。在新型抗抑郁药中，米安色林、诺米芬辛和安非他酮最初在心血管效应方面似乎最有前景，但随后证明有其他严重问题；这些药物需要进一步测试。曲唑酮已成为过量服用时死亡风险最低的抗抑郁药，并且是已有传导疾病患者的标准三环类抗抑郁药的有用替代品。然而，曲唑酮治疗与一些不良反应有关，因此，从本文给出的数据可以得出结论，目前可用的药物都有一定的心血管风险。
