Roose S P, Glassman A H
Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York 10032.
J Clin Psychiatry. 1994 Sep;55 Suppl A:83-7; discussion 88-9, 98-100.
At one point it was believed that the systematic study of the cardiovascular effects of therapeutic levels of tricyclic antidepressants had established the relative safety of these drugs even in patients with significant cardiovascular disease. However, recent studies demonstrating a deleterious effect of antiarrhythmic agents in patients with ischemic heart disease have significant implication for conclusions about tricyclic safety. Studies in cardiology designed to demonstrate that suppression of ventricular arrhythmia in the post-myocardial infarction period would reduce mortality produced the unexpected opposite result, i.e., patients treated with class I antiarrhythmic drugs actually had an increase in their mortality rate. Since tricyclics are classified as type IA antiarrhythmics, it would seem prudent to assume that they have similar risks unless proven otherwise. Other drugs such as the serotonin selective reuptake inhibitors or bupropion, which may be safer than the tricyclics from the cardiovascular perspective, have yet to establish their efficacy in the older and more severely depressed patient population.
曾有观点认为，对三环类抗抑郁药治疗剂量下心血管效应的系统研究已证实，即便在患有严重心血管疾病的患者中，这些药物也具有相对安全性。然而，近期关于抗心律失常药物对缺血性心脏病患者产生有害影响的研究，对三环类药物安全性的结论有着重大启示。心脏病学领域旨在证明心肌梗死后抑制室性心律失常可降低死亡率的研究，却得出了意外的相反结果，即使用I类抗心律失常药物治疗的患者死亡率实际上有所上升。鉴于三环类药物被归类为IA型抗心律失常药，在未得到反证之前，假定它们具有类似风险似乎是谨慎之举。其他药物，如5-羟色胺选择性再摄取抑制剂或安非他酮，从心血管角度看可能比三环类药物更安全，但在老年及重度抑郁症患者群体中尚未证实其疗效。
