Major Findings

A study comparing trazodone and amitriptyline on cardiovascular function in patients with major depression found that amitriptyline had the expected effects on the electrocardiograph and systolic time intervals, consistent with its known anticholinergic and quinidine-like properties. 3 Trazodone, in contrast, showed no quinidine-like effects and only minor effects on systolic time intervals. 3 However, trazodone was not entirely without cardiovascular effects. 3 Although trazodone appeared safer than amitriptyline, long-term monitoring is needed to understand the minor effects on heart rate and T wave changes. 3

Another study examining the interaction of alcohol with amitriptyline, fluoxetine, and placebo in healthy subjects found that amitriptyline was less well tolerated than fluoxetine, and there were some subjective interactions with alcohol, though not additive or potentiating. 2 This reflected the already substantial effects of amitriptyline alone. 2

A study comparing the cardiovascular and anticholinergic effects of femoxetine and amitriptyline in healthy men found that femoxetine had a greater effect on systolic time intervals than amitriptyline, while amitriptyline caused a delay in intracardiac conduction. 1 Both femoxetine and amitriptyline increased heart rate compared to placebo, with a greater increase observed with amitriptyline. 1

A study comparing the cardiovascular effects of mianserin and amitriptyline in healthy subjects found that mianserin had fewer adverse cardiac effects than amitriptyline. 4 While amitriptyline showed a negative effect on myocardial contractility, mianserin reduced left ventricular end-systolic volume, possibly by increasing ejection fraction. 4 This suggests that tricyclic antidepressants may have adverse cardiac effects at therapeutic doses, while the tetracyclic mianserin appears to be free of such unwanted properties. 4

Benefits and Risks

Benefit Summary

These studies suggest that some antidepressants can affect the cardiovascular system, but these effects vary between medications and may not apply to all individuals. Trazodone appears to be a safer medication than amitriptyline, with fewer cardiovascular effects. 3 Femoxetine also increased heart rate compared to placebo, but its anticholinergic effects were weaker and it may be better tolerated than amitriptyline. 1 Mianserin, compared to tricyclic antidepressants, seems to have fewer adverse effects on the cardiovascular system and may have fewer side effects. 4

Risk Summary

Tricyclic antidepressants such as amitriptyline can have adverse effects on the cardiovascular system, including increased heart rate and delayed intracardiac conduction. 3 1 These effects have been confirmed through electrocardiograms and systolic time interval measurements. 3 1 While trazodone appears to be a safer medication than amitriptyline, long-term monitoring is needed to understand the minor effects on heart rate and T wave changes. 3 Amitriptyline is also less well tolerated than fluoxetine and has been observed to interact with alcohol. 2

Comparison between Studies

Commonalities

All of these studies suggest that antidepressants can potentially impact the cardiovascular system. 3 2 1 4 These effects are confirmed through electrocardiograms and systolic time interval measurements. 3 1 Additionally, these studies suggest that the cardiovascular effects of antidepressants differ between medications. 3 1 4

Differences

The studies varied in the medications examined and the research designs used. For example, one study compared the cardiovascular effects of trazodone and amitriptyline, while another study compared femoxetine and amitriptyline. 3 1 Additionally, one study involved healthy subjects, while another study involved individuals with depression. 3 2

Consistency and Contradictions in Results

These studies consistently suggest that antidepressants can affect the cardiovascular system, and these effects vary between medications. 3 1 4 Specifically, tricyclic antidepressants such as amitriptyline can increase heart rate and delay intracardiac conduction. 3 1 Other medications, like trazodone and femoxetine, do not appear to have as significant of an impact on the cardiovascular system as amitriptyline. 3 1 Mianserin, compared to tricyclic antidepressants, seems to have fewer adverse effects on the cardiovascular system. 4

Considerations for Real-life Application

It's crucial to be aware of the potential cardiovascular effects of antidepressants if you are taking them. 3 1 4 Tricyclic antidepressants such as amitriptyline may pose a higher risk for individuals with pre-existing conditions like heart disease or high blood pressure. 3 1 It is vital to discuss your medical history and any other medications you are taking with your doctor before starting antidepressants. 3 1 4

Limitations of Current Research

These studies are all relatively small, and their findings should be generalized with caution. 3 2 1 4 Additionally, while these studies investigated the cardiovascular effects of specific antidepressants, similar research is needed for other antidepressants as well. 3 1 4

Future Research Directions

To further investigate the cardiovascular effects of antidepressants, larger studies are required. 3 1 4 Studies comparing the cardiovascular effects of various antidepressants are also essential. 3 1 4 These studies can provide a deeper understanding of the cardiovascular effects of antidepressants and contribute to the development of safer treatment options. 3 1 4

Conclusion

These studies suggest that some antidepressants can affect the cardiovascular system. 3 1 4 However, these effects vary between medications and may not apply to all individuals. 3 1 4 It's crucial to be aware of the potential cardiovascular effects of antidepressants if you are taking them. 3 1 4 Especially for individuals with pre-existing conditions like heart disease or high blood pressure, the risks may be higher. 3 1 Before starting antidepressants, consulting your doctor about your medical history and any other medications you are taking is essential. 3 1 4