Nortriptyline treatment in depressed patients with left ventricular impairment did not change ejection fraction and caused orthostatic hypotension in only 5% of patients.
Observational (n=21)
Does nortriptyline affect ejection fraction or cause orthostatic hypotension in depressed patients with left ventricular impairment?
Nortriptyline appears to be a relatively safe treatment for depression in patients with left ventricular impairment, causing minimal orthostatic hypotension and no change in ejection fraction.
Previous studies of the effect of tricyclic antidepressants on left ventricular function in depressed patients with moderate to severe ventricular impairment have focused primarily on imipramine hydrochloride. In a prior study, we found that although imipramine had no effect on ejection fraction as measured by first-pass radionuclide angiography, the treatment could not be tolerated by 50% of the patients because of intolerable drug-induced orthostatic hypotension. Nortriptyline hydrochloride is an effective antidepressant that, in depressed patients without heart disease, causes significantly less orthostatic hypotension than imipramine. To see if this advantage could be safely extended to patients with congestive failure, we measured the effect of nortriptyline on ejection fraction and blood pressure in 21 depressed patients with left ventricular impairment. Ejection fraction was unchanged by nortriptyline treatment, and orthostatic hypotension developed in only one (5%) of 21 patients. Nortriptyline emerges as a relatively safe treatment for depression in patients with left ventricular impairment.
Steven P. Roose (1986) conducted an observational in Depression with left ventricular impairment (n=21). Nortriptyline was evaluated on Ejection fraction and orthostatic hypotension. Nortriptyline treatment in depressed patients with left ventricular impairment did not change ejection fraction and caused orthostatic hypotension in only 5% of patients.