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.Abstract Teaser