Glassman A H, Roose S P
Department of Clinical Psychopharmacology, College of Physicians and Surgeons, Columbia University, New York, N.Y. 10032.
Gerontology. 1994;40 Suppl 1:15-20. doi: 10.1159/000213616.
Unexpected events have occurred in cardiology over the last 4 years. A study by the Heart and Lung Institute of the National Institute of Health in the mid-1980s showed to great surprise that class I antiarrhythmic drugs given to patients with ventricular arrhythmias following myocardial infarction, instead of preventing deaths, actually increased the number of patients dying. Since then, a series of studies has consistently confirmed this original observation. The problem for psychiatry is that the tricyclic antidepressant (TCA) drugs are also class I antiarrhythmics. There is every reason to believe that a similar increased risk of death would exist with the TCAs. It is, therefore, important for psychiatrists to understand the cause and magnitude of this excess in deaths. Evidence to date would suggest that all class I compounds, despite being powerful antiarrhythmics under usual physiological conditions, become proarrhythmic under anoxic conditions. Such conditions would exist in ischaemic heart disease during angina and, particularly, myocardial infarction. How this might alter our use of TCAs and whether this happens with the selective serotonin reuptake inhibitors is discussed.
在过去四年里，心脏病学领域发生了一些意外事件。美国国立卫生研究院心肺研究所于20世纪80年代中期进行的一项研究令人惊讶地发现，给心肌梗死后患有室性心律失常的患者使用I类抗心律失常药物，非但没有预防死亡，实际上还增加了死亡患者的数量。从那时起，一系列研究不断证实了这一最初的观察结果。精神病学面临的问题是，三环类抗抑郁药（TCA）也属于I类抗心律失常药物。完全有理由相信，TCA药物也会存在类似的死亡风险增加情况。因此，精神科医生了解这种额外死亡的原因和程度非常重要。迄今为止的证据表明，所有I类化合物尽管在通常生理条件下是强效抗心律失常药物，但在缺氧条件下会变成促心律失常药物。在心绞痛尤其是心肌梗死期间的缺血性心脏病中就会存在这样的条件。本文将讨论这可能如何改变我们对TCA药物的使用，以及选择性5-羟色胺再摄取抑制剂是否也会出现这种情况。
