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Biomedical subjects

S Woodring

Publications and source records attributed to S Woodring.

13 recordsLinked to original sources
PubMed1998

Cardiovascular effects of fluoxetine in depressed patients with heart disease.

OBJECTIVE: The purpose of this study was to determine the cardiovascular effects of fluoxetine in depressed patients with cardiac disease. METHOD: Twenty-seven depressed patients (26% of whom were female and whose average age was 73 years) who had congestive heart failure, conduction disease, and/or ventricular arrhythmia were studied in an open medication trial of fluoxetine, up to 60 mg/day, for 7 weeks. The main outcome measures were heart rate and rhythm measured by 24-hour ECG recordings, ejection fraction determined by radionuclide angiography, cardiac conduction intervals, and blood pressure. Baseline values were compared with those at weeks 2 and 7 of fluoxetine treatment. In 60 comparable patients, values of these same cardiovascular measures at baseline and after 3 weeks of treatment with a tricyclic antidepressant, nortriptyline, were also examined. RESULTS: Fluoxetine induced a statistically significant 6% decrease in heart rate, a 2% increase in supine systolic pressure, and a 7% increase in ejection fraction. There was no effect on cardiac conduction, ventricular arrhythmia, or orthostatic blood pressure. Overall, 4% of the fluoxetine patients had an adverse cardiovascular effect. In contrast, nortriptyline treatment caused a significant increase in heart rate and orthostatic hypotension, and 20% of the nortriptyline-treated patients had an adverse cardiovascular effect. CONCLUSIONS: In depressed patients with heart disease, fluoxetine treatment was not associated with the cardiovascular effects documented for the tricyclic antidepressants or with significant adverse cardiac events. However, limited conclusions about fluoxetine's cardiovascular effects and safety can be drawn from this study of only 27 patients monitored for 7 weeks.

Adult↗
PubMed1994

Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia.

OBJECTIVE: The popularity of selective serotonin reuptake inhibitors stems from their apparent efficacy for numerous disorders and their favorable side effect profile. However, several studies have suggested that selective serotonin reuptake inhibitors may be relatively ineffective for treating melancholia. The objective of this study was to compare the responses to fluoxetine and nortriptyline of older patients with both severe depression and heart disease. METHOD: The outcome of 22 hospitalized patients with unipolar depression and heart disease who were treated with fluoxetine was compared to the outcome of 42 comparable patients treated with nortriptyline. The average age of the fluoxetine group was 73 years, and their mean pretreatment score on the Hamilton Depression Rating Scale was 26; the average age of the nortriptyline group was 70, and their mean pretreatment Hamilton score was 28. RESULTS: Of the 42 nortriptyline-treated patients, 28 were responders, six were nonresponders, and eight dropped out. The intent-to-treat response rate was 67% (28 of 42), and the response rate of the melancholic patients who completed the nortriptyline trial was 83% (20 of 24). Of the 22 fluoxetine-treated patients, five were responders, 13 were nonresponders, and four dropped out. The intent-to-treat response rate was 23% (five of 22), and the response rate of the melancholic patients who completed the fluoxetine trial was 10% (one of 10). CONCLUSIONS: Fluoxetine appears to be significantly less effective than nortriptyline for treating hospitalized elderly patients with unipolar major affective disorder, especially those with the melancholic subtype and concurrent cardiovascular disease.

Age Factors↗
PubMed1993

Cardiovascular complications of ECT in depressed patients with cardiac disease.

OBJECTIVE: This study was conducted to determine the safety of electroconvulsive therapy (ECT) for depressed patients with serious cardiac disease. METHOD: The rate of complications in 40 patients with major depressive disorder and left ventricular impairment, ventricular arrhythmias, and/or conduction delay who received ECT was compared to the rate of complications in a matched comparison group of 40 depressed patients without cardiac disease who also received ECT. In addition, 21 of the patients with cardiac illness had received one or more inpatient trials of tricyclic antidepressants before receiving ECT, thereby permitting a comparison of cardiovascular complications of medication and ECT in the same patients. RESULTS: The patients with cardiac disease had a significantly higher rate of cardiac complications during ECT than did the comparison group without cardiac disease. The type of preexisting cardiac abnormality strongly predicted the type of cardiac complication that occurred during ECT. However, most of the complications were transitory and did not prevent the completion of ECT. Of the 21 patients with cardiac disease who had received tricyclic trials before ECT, 11 had been forced to discontinue drug treatment because of substantial cardiovascular side effects. In comparison, 38 of the 40 cardiac patients completed the course of ECT. CONCLUSIONS: With close monitoring for the development of arrhythmia and ischemic episodes, ECT can be given with relative safety to patients with severe cardiovascular disease.

Aged↗
PubMed1991

Cardiovascular effects of bupropion in depressed patients with heart disease.

OBJECTIVE: The cardiovascular effects of therapeutic plasma levels of tricyclic antidepressants in depressed patients with and without preexisting cardiac disease have been well characterized and include orthostatic hypotension and conduction delay. Bupropion, structurally unrelated to tricyclic antidepressants, is relatively free of cardiac side effects in depressed patients without cardiac disease. However, it is unknown whether bupropion is safe for depressed patients with preexisting heart disease, so the authors studied the cardiovascular effects of bupropion in such patients. METHOD: The subjects were 36 inpatients with DSM-III major depression and preexisting left ventricular impairment (N = 15), ventricular arrhythmias (N = 15), and/or conduction disease (N = 21). The patients continued their cardiac drug regimens and received bupropion for 3 weeks (mean +/- SD dose = 442 +/- 47 mg/day). Cardiovascular functioning was measured by pulse, blood pressure, high-speed ECG, 24-hour portable ECG, and radionuclide angiography. RESULTS: Although bupropion caused a rise in supine blood pressure, it did not cause significant conduction complications, did not exacerbate ventricular arrhythmias, had a low rate of orthostatic hypotension, and had no effect on pulse rate. However, bupropion treatment was discontinued for 14% of the patients because of adverse effects, including exacerbation of baseline hypertension in two patients. CONCLUSIONS: The cardiovascular profile of bupropion may make this drug a useful agent in the treatment of the depressed patient with preexisting cardiovascular disease. Further studies, with longer durations of bupropion treatment and more subjects, are needed to confirm these findings.

Aged↗
PubMed1991

Is doxepin a safer tricyclic for the heart?

BACKGROUND: Many clinicians believe that doxepin is the safest tricyclic with respect to cardiovascular effects. This belief has persisted for two decades despite the absence of rigorous prospective evaluation. METHOD: To address this issue, the authors studied the cardiovascular effects of doxepin in 32 depressed patients with preexisting left ventricular impairment, ventricular arrhythmias, and/or conduction disease. RESULTS: Doxepin (1) did not have a robust effect on heart rate, (2) did not adversely affect left ventricular function, (3) did have a significant antiarrhythmic effect, (4) slowed cardiac conduction, and (5) caused a significant increase in orthostatic hypotension. Five (16%) of the 32 patients dropped out due to cardiovascular side effects. The overall dropout rate was 41%. CONCLUSIONS: The cardiovascular effects of doxepin in depressed patients with heart disease are comparable to those documented for imipramine and nortriptyline. Doxepin afforded no greater margin of cardiovascular safety; in fact, the drug was poorly tolerated by this patient population.

Aged↗
PubMed1991

Death, depression, and heart disease.

A complex multidimensional relationship exists between affective disorder and cardiac disease, specifically with respect to pathophysiology, prognosis, and treatment. Though there are a number of possible perspectives from which to view this relationship, in this paper we concentrate on the depressed patient with preexisting cardiac disease with respect to (1) the rates of concurrence of the two disorders, (2) the influence of affective disorder on the prognosis of cardiac disease, and (3) the safe and effective treatment of depression in patients with preexisting illness.

Comorbidity↗
PubMed1987

Tricyclic antidepressants in depressed patients with cardiac conduction disease.

The observation that fatalities from tricyclic antidepressant (TCA) overdose are associated with heart block and/or arrhythmias has led to concern about the cardiovascular effects of TCAs. Contrary to expectations, studies have shown TCAs to be relatively safe in patients without heart disease. However, it is unclear whether these drugs are also safe in patients with heart disease. This prospective study compared the risk of cardiovascular complication at therapeutic plasma concentrations of TCAs in 196 depressed patients, 155 with normal electrocardiograms and 41 with either prolonged PR interval and/or bundle-branch block. The prevalence of second-degree atrioventricular block was significantly greater in patients with preexisting bundle-branch block (9%) than in patients with normal electrocardiograms (0.7%). Orthostatic hypotension occurred significantly more frequently with imipramine than with nortriptyline, and in patients with heart disease.

Antidepressive Agents, Tricyclic↗
PubMed1986

Nortriptyline in depressed patients with left ventricular impairment.

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.

Aged↗
PubMed1986

Tricyclic nonresponders: phenomenology and treatment.

In an attempt to identify characteristics of tricyclic antidepressant nonresponders, the authors reviewed the records of inpatients with unipolar, nondelusional depression who had received adequate treatment (confirmed by plasma level determination) with tricyclics. The 17 patients who failed to respond were compared to a group of tricyclic responders with respect to demographic and phenomenologic variables. Although the nonresponders tended to have more previous episodes of depression and higher anxiety scores on the pretreatment Hamilton scale than the responders, they could not be distinguished from the responders by clinical or demographic data. All of the patients who failed to respond to tricyclics subsequently responded to monoamine oxidase inhibitors and/or ECT.

Antidepressive Agents, Tricyclic↗
PubMed1983

Depression, delusions, and suicide.

A retrospective analysis of all the suicides at the New York State Psychiatric Institute over a 25-year period was carried out. The authors retrospectively assigned diagnoses according to Research Diagnostic Criteria and DSM-III and found that among the patients who committed suicide there were 14 with unipolar endogenous depression. Of those 14 patients, 10 were considered delusional or probably delusional. In comparison, a control group of similarly diagnosed depressed patients taken from the same institution over the same time period included far fewer delusional depressions. Thus, there was a significant association between delusions and suicide: A delusionally depressed patient was five times more likely to commit suicide than a nondelusional one.

Delusions↗