Long-term ECG changes in depressed elderly patients treated with nortriptyline. A double-blind, randomized,...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Nortriptyline (NT) is a tricyclic antidepressant with known cardiovascular effects.
• Long-term cardiovascular safety data for nortriptyline, especially in patients with pre-existing cardiac conditions, is crucial.

Purpose of the Study:

• To evaluate the long-term electrocardiographic (ECG) effects of nortriptyline (NT).
• To compare ECG changes in patients with and without pre-existing cardiac disease during long-term NT treatment.

Main Methods:

• Prospective study involving 50 patients completing a long-term nortriptyline trial.
• Electrocardiograms (ECGs) were recorded at baseline, 7 weeks, and 1 year of treatment.
• Comparison of ECG parameters between patients with and without pre-existing cardiac disease.

Main Results:

• Significant ECG changes and increased heart rate were observed by week 7 and persisted up to a mean of 55 weeks in patients on continuous NT.
• No significant difference in long-term ECG effects was found between patients with and without pre-existing cardiac disease.
• ECG changes reverted to baseline upon substitution with placebo, indicating reversibility.

Conclusions:

• Long-term nortriptyline treatment leads to persistent ECG changes and increased heart rate.
• Patients with pre-existing cardiac disease tolerated nortriptyline without significantly worse ECG changes compared to non-cardiac patients.
• The cardiovascular effects of nortriptyline are reversible upon discontinuation.