The use of imipramine in depressed patients with congestive heart failure

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Abstract
Previous studies of left ventricular performance (LVP) in depressed patients receiving tricyclic antidepressants have been performed on patients without severe heart disease. The effect of imipramine hydrochloride on LVP was assessed by radionuclide angiography in a group of depressed patients with notable preexisting left ventricular dysfunction. Ejection fraction was measured at rest by 1st-pass radionuclide angiography before and after treatment with imipramine. Ejection fraction was unchanged during treatment, but 7 of 15 patients experienced orthostatic hypotension of such severity that administration of the drug had to be discontinued. Plasma concentrations of the drug were essentially twice those usually seen. Although imipramine does not further impair resting LVP, this does not mean it is without risk. The physician must watch carefully for orthostatic hypotension when using imipramine in depressed patients with impaired LVP.