Cardiovascular effects of bupropion in depressed patients with heart disease

Article Abstract:

A class of drugs known as tricyclic antidepressants work by increasing the effects of excitatory or stimulating chemical messengers in the central nervous system. Unfortunately, tricyclics taken in overdoses lead to heart block or arrhythmias (unstable heart beat), and in normal doses can lead to disturbances in heart rhythm and other cardiovascular complications in depressed patients with or without heart disease. Bupropion is a relatively new type of antidepressant which is chemically unrelated to the tricyclics, and has been shown to be relatively free of cardiac side-effects in depressed patients who do not have cardiac problems. To evaluate the cardiovascular effects of bupropion in depressed patients who do have heart conditions, 14 men and 22 women with an average age of 69 years were studied over a three-week period. The patients in the study had various heart diseases, including: congestive heart failure (engorgement of the heart with fluid due to inefficient pumping), conduction disease (irregularities in the electrical impulses in the heart), and ventricular arrhythmias (irregular ventricular contractions which weaken the pumping action of the heart). Pre-treatment (baseline) cardiac measurements were assessed before bupropion was administered. For the three weeks of the study, blood pressure (BP), pulse, and various cardiovascular functions were measured up to three times daily. Bupropion induced a significant increase in supine (lying down) BP and resulted in a clinically insignificant drop in orthostatic BP (lowered BP caused by shifting from a supine to a standing position), but did not cause conduction complications, worsen ventricular arrhythmias, or affect pulse rate. Bupropion treatment was discontinued for 15 percent of the patients, primarily due to increased hypertension (high BP). Results indicate that bupropion treatment causes less orthostatic drop and fewer problems with ventricular contractions or conduction than tricyclic treatment, but should be used with caution for patients with hypertension. Further studies evaluating the effects of bupropion for a longer time-span and among a greater number of depressed cardiac patients are required. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Heart, Cardiovascular system, Circulatory system, Antidepressants, Bupropion

---

Response to treatment with antidepressants of patients with severe or moderate nonpsychotic depression and of patients with psychotic depression

Article Abstract:

Psychotic unipolar major depression has traditionally been treated with tricyclic antidepressants. However, poor response to this treatment has made electroconvulsive treatments (ECT) and combination antipsychotic and tricyclic drug therapies more popular. The reason for poor response to tricyclic antidepressants in these patients is not clear. It may be related to the severity of illness, or to a qualitative difference that is related to the psychotic state. In an attempt to clarify this issue, three groups of hospitalized patients were assessed. The first group of 53 patients were diagnosed as nonpsychotic severely depressed; the second group of 54 patients were nonpsychotic moderately depressed; and the third group consisted of 25 psychotic depressed patients. It was hypothesized that if the lack of response was attributable to severity of disease, the nonpsychotic severe depressed group and the psychotic severely depressed group would respond similarly to tricyclic therapy, and would both be distinguished from the moderately depressed group. After four weeks of treatment with the tricyclic antidepressants amitriptyline and imipramine, the moderately depressed, nonpsychotic group responded better than the other two groups. An intermediate response was noted in the nonpsychotic severely depressed group; degree of response was between the psychotic depressed group and the nonpsychotic moderately depressed group. Although these results were obtained from a relatively small number of patients, they suggest that the response to tricyclic antidepressant treatment alone in patients with nonpsychotic severe major depression may not be as good as in those with nonpsychotic moderate major depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Imipramine, Amitriptyline

---

Left prefrontal glucose hypometabolism in the depressed state: a confirmation

Article Abstract:

Previous studies of depressed patients have found a reduction of glucose metabolism (hypometabolism) in the left dorsal anterolateral prefrontal cortex area of the brain. After successful treatment of these patients, relative metabolic rate increased on the left, but no change occurred on the right side. Other findings have also indicated reduced metabolic activity in the frontal portion of the brain and in the whole brain of depressed subjects. To replicate these results, 10 severely depressed subjects were examined before and after tricyclic antidepressant treatment, using positron emission tomography (PET scanning) and fluorodeoxyglucose tests; measurements of regional cerebral metabolism of glucose in the brain were obtained. The 10 experimental subjects consisted of seven patients diagnosed with bipolar disorder and three with unipolar depressive disorder; 10 normal control subjects of comparable age were also evaluated. The results confirmed the previous findings of left-right prefrontal asymmetry in the brain, which was detected in the depressed patients before successful treatment, but not afterwards. This suggests the efficacy of tricyclic antidepressants in reducing asymmetry. In addition, depressed patients had significant frontal and whole-cortex hypometabolism when compared with the normal controls. This was observed before treatment and persisted after treatment, even if clinical improvements in the patient were noted. These results suggest that this feature of hypometabolism in depressed individuals may not be state-dependent. Implications of these data are discussed and additional research is recommended to further investigate these brain abnormalities in depressed patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Measurement, Brain, Brain research, Glucose metabolism, Cerebral hemispheres

Similar abstracts:

• Abstracts: Plasma homocysteine levels in female patients with eating disorders. Effect of inositol on bulimia nervosa and binge eating
• Abstracts: Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. Psychopathology of very mild dementia of the Alzheimer type
• Abstracts: Attribution and expressed emotion in the relatives of patients with schizophrenia. Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism
• Abstracts: Hypnotizability and dissociation. Disturbed body image in patients with eating disorders. Hypnotizability of psychiatric inpatients according to two different scales
• Abstracts: Regional variation in patterns of inpatient psychiatric care. part 2 Experiences of a paraplegic psychiatry resident on an inpatient psychiatric unit

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.