[The problem of side-effects: cardiotoxicity (author's transl)]

Area of Science:

• Pharmacology
• Cardiology
• Psychiatry

Background:

• Cardiotoxicity is a known side effect of tricyclic antidepressants (TCAs).
• Potential mechanisms include the tricyclic ring structure, the dimetilaminic group, and norepinephrine (NA) reuptake inhibition in the myocardium.
• A study was needed to compare cardiotoxicity across different antidepressant classes.

Purpose of the Study:

• To investigate and compare the cardiotoxicity of different antidepressant drugs.
• To evaluate the cardiac effects of a quadricyclic (mianserin) versus several tricyclic antidepressants (amineptine, amitriptyline, chlorimipramine).
• To assess cardiac function in patients with anxious and retarded depression treated with these agents.

Main Methods:

• A double-blind, cross-over study design was employed.
• Four drugs were selected: mianserin (quadricyclic), amineptine, amitriptyline, and chlorimipramine (all TCAs).
• Patients with retarded depression received amineptine then chlorimipramine; patients with anxious depression received mianserin then amitriptyline. Cardiac function was assessed using computerized cycloergometer tests, ECG, and depression evaluations (Minnesota methodology).

Main Results:

• The quadricyclic antidepressant, mianserin, did not demonstrate cardiotoxicity.
• All evaluated tricyclic antidepressants showed signs of cardiotoxicity.
• Amitriptyline exhibited the most pronounced cardiotoxicity among the TCAs studied.

Conclusions:

• Mianserin appears to be a safer alternative regarding cardiotoxicity compared to TCAs.
• TCAs, especially those with long side chains like amitriptyline, pose a significant risk of cardiotoxicity.
• Further research into TCA cardiotoxicity mechanisms and safer alternatives is warranted.