CARDIAC EFFECTS of cyclic antidepressants have been recognized by physicians as potentially hazardous to patients with preexisting cardiac disease. In recent years clinical investigators have shown that cyclic antidepressants exert antiarrhythmic effects when plasma concentrations are therapeutic for depression. Previous studies have examined the role of imipramine and nortriptyline as antiarrhythmics. Other cyclic antidepressants are believed to share similar antiarrhythmic properties, but to date clinical studies or case reports have described the arrhythmogenic potential of these medications only in overdose or poisoning. This case report details the electro-physiologic and pharmacologic record of the beneficial and safe use of amitriptyline in a patient with a history of severe cardiac arrhythmias and organic affective disorder with pseudobulbar palsy.
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