High Doses of ‘Older’ Antidepressants Seen Risky

There appears to be an association between the risk of sudden cardiac death and use of relatively high doses of the tricyclic type of antidepressants (TCAs), investigators report.

There appears to be an association between the risk of sudden cardiac death and use of relatively high doses of the tricyclic type of antidepressants (TCAs), investigators report. However, the risk is not increased with the newer type of antidepressants called selective serotonin reuptake inhibitors (SSRIs), or TCAs at doses less than 100 milligrams per day, according to results of a study published in the Clinical Pharmacology and Therapeutics. TCAs include drugs such Etrafon and Sinequan, and numerous generic products. “TCAs, used frequently for the treatment of depression and several other indications, have cardiovascular effects that may increase the risk of sudden cardiac death,” Dr. Wayne A. Ray, of Vanderbilt University, in Nashville, Tennessee, and colleagues write. Using Tennessee Medicaid records from 1998 through 1993, the team examined data on antidepressant use and the risk of sudden cardiac death. There were 1487 confirmed sudden cardiac deaths, the researchers report. They found that for current users of TCAs the risk of cardiac death increased along with the dosage, compared with non-users of antidepressants. The rate of cardiac arrests did not increase with TCA doses lower than 100 milligrams per day, but more than doubled for doses of at least 300 milligrams. The rate with use of SSRIs at any dose was the same as among people who did not take any antidepressants. These finding suggest that clinicians should use caution in prescribing higher doses of TCAs, “particularly in patients aged 65 years or older or with pre-existing cardiovascular disease,” Ray and colleagues write. (Source: Clinical Pharmacology and Therapeutics: Reuters Health News: May 2004)