Nortriptyline treatment of depressed cardiac transplant recipients

Article Abstract:

Heart transplant recipients are prone to depressive disorders. Treatment has been complicated by the adverse cardiovascular side effects commonly associated with the use of tricyclic antidepressants, including low blood pressure when standing or sitting (orthostatic hypotension), and disturbances in cardiac conduction. However, one tricyclic, nortriptyline, has been shown to be safe for use among patients with impaired ventricular function, and to have relatively low risk for orthostatic hypotension. To evaluate the effects of nortriptyline on major depression in cardiac transplant recipients, eight patients began nortriptyline therapy within 2 to 18 months of heart transplant. They were given routine measures to assess heart rate, blood pressure while supine, sitting and standing, and blood levels of nortriptyline. Seven of the eight patients demonstrated clinical improvement in depressive symptoms. Treatment did not result in any significant effects on blood pressure. None of the patients developed orthostatic hypotension. All cardiovascular effects were insignificant and well tolerated by the patients. The finding that nortriptyline is a safe and effective drug for treating depression in heart transplant patients is promising, but should be viewed with caution. Further evaluation among a much larger sample of transplant patients, and more specific measures of cardiac function during nortriptyline therapy are required. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Evaluation, Drug therapy, Depression, Mental, Depression (Mood disorder), Heart, Heart transplantation, Cardiac patients, Nortriptyline

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Emergence of intense suicidal preoccupation during fluoxetine treatment

Article Abstract:

Some adverse reactions to antidepressant drugs have been observed in severely depressed patients. Occasionally, suicidal behavior will be induced as a side effect of one of these drugs. However, this is usually associated with individuals who already have pre-existing suicidal thoughts. The case histories of six patients who developed an intense preoccupation with suicide after being treated with fluoxetine are presented. None of these patients had experienced similar reactions with any previous psychotropic drug treatments. All the patients were optimistic and hopeful regarding their treatment prior to administration of fluoxetine. Suicidal thoughts began about two weeks after fluoxetine treatment commenced, and the duration of these thoughts lasted from three days to three months. The suicidal behavior observed in these patients was of a particularly violent nature and most were preoccupied with fantasies of self-destruction. The reason for the behavior observed in these patients is unknown. Fluoxetine is a strong serotonergic inhibitor and it was suggested that serotonin may play a role in this side effect. Although this adverse effect has been observed in only a small fraction of those taking fluoxetine, caution is recommend in the administration of this drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Suicide

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A case of fluoxetine-induced serum sickness

Article Abstract:

Fluoxetine is an antidepressant that inhibits the uptake of the neurotransmitter serotonin. A 27-year-old man developed the symptoms of serum sickness, a hypersensitivity reaction, including fever, itchy rash, painful joints, abdominal pain, mild diarrhea, and enlarged lymph nodes and spleen, after taking fluoxetine for three weeks. His allergy history consisted of an occasional bout with hay fever. The clinical course and features were consistent with serum sickness, as was the rapid resolution of symptoms with corticosteroid treatment. This is believed to be the first documented report of fluoxetine-induced serum sickness, which cannot be predicted with skin tests or confirmed with challenge tests. It is suggested that patients experiencing similar reactions to fluoxetine be advised against future ingestion and be given an alternative prescription.

Serum sickness

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