Cardiovascular effects of tricyclic antidepressants in childhood asthma: a case series and review
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M Z Wamboldt1, A G Yancey, T A Roesler
1National Jewish Medical and Research Center, University of Colorado Health Sciences Center, Denver, USA.
Insights
Antidepressants can be safely used in children with asthma, with most tolerating treatment despite potential cardiovascular side effects. This study found that most pediatric asthma patients continued antidepressant therapy with manageable adverse events.
Area of Science:
- Pediatric pulmonology
- Child and adolescent psychiatry
- Clinical pharmacology
Background:
- Asthma in children often co-occurs with anxiety and depression, impacting treatment adherence and outcomes.
- Previous research on antidepressant use in pediatric asthma indicated significant side effects leading to treatment discontinuation.
- The potential for drug interactions between asthma medications and antidepressants requires careful consideration.
Purpose of the Study:
- To retrospectively review chart data and assess the safety and tolerability of antidepressant use in pediatric patients with asthma.
- To identify the types and frequency of adverse events associated with antidepressant therapy in this population.
- To evaluate the feasibility of continuing antidepressant treatment in children with asthma receiving multiple asthma medications.
Main Methods:
- Retrospective chart review of 40 pediatric inpatients with asthma (mean age 13.3 years).
- Patients were receiving an average of 5 asthma medications and were administered various antidepressants.
- Data collected included asthma severity, duration of treatment, comorbid diagnoses, and adverse events.
Main Results:
- 36 out of 40 children continued antidepressant therapy.
- Cardiovascular side effects (tachycardia, hypertension, postural hypotension) occurred in 5 subjects (4 on TCAs, 1 on fluoxetine), with 3 able to continue treatment.
- Two subjects discontinued antidepressants due to hypomanic symptoms; no seizures or ECG changes were reported.
Conclusions:
- Antidepressants appear to be generally well-tolerated and can be safely administered to children with asthma, even when on multiple asthma medications.
- Cardiovascular side effects are possible, particularly with tricyclic antidepressants, but often manageable.
- Further research into specific drug interactions between asthma and antidepressant therapies is warranted.
Abstract:
Children with asthma frequently have significant anxiety and depression that interfere with treatment outcome. Although the use of antidepressants may be helpful, in the one published study of antidepressant use in pediatric asthma, significant side effects necessitated discontinuance; these side effects were increased motor activity, impulsive behavior, insomnia, postural hypotension, premature auricular contractions, diastolic hypertension, and generalized seizure. The objective of this retrospective chart review was to examine whether antidepressants could be tolerated and administered safely to children on asthma medications. Forty pediatric inpatients (mean age 13.3 years, range 7-19) with varying levels of asthma severity (5 mild, 11 moderate, 24 severe) and an average duration of asthma treatment of 10.0 years were administered antidepressants while also taking an average of 5 medications for asthma (range 2-7). Ten of the patients had an additional comorbid medical diagnosis. There were 17 children diagnosed with a primary affective disorder; 7 with a primary anxiety disorder; and 16 with both an affective and anxiety disorder. Thirty-six children ultimately were continued on an antidepressant: 13 on desipramine, 9 on nortriptyline, 6 on imipramine, 4 on fluoxetine, 3 on bupropion, and 1 on sertraline. Significant cardiovascular side effects (tachycardia, hypertension, and postural hypotension) occurred in 4 subjects on tricyclic antidepressants (TCAs) and 1 subject on a non-TCA (fluoxetine); 3 of these subjects were able to continue treatment with an antidepressant. Two subjects were taken off antidepressants because of hypomanic symptoms (increased motor activity, mood lability, impulsive behavior, and insomnia). No medications were discontinued because of electrocardiogram changes, arrhythmias, or seizures. Doses of TCAs were comparable to those in previous studies, but the asthma medications differed. Discussion of current anti-asthmatic medications and potential for interactions with antidepressants is included.