NORTRIPTYLINE-INDUCED DEPRESSION OF VENTILATORY CONTROL IN A PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Psychiatric disorders occur frequently in patients with COPD, but ther apy with psychotropic drugs is often limited by concomitant depression of ventilatory drive. We present a patient with COPD and major depres sion who developed hypercapnic respiratory failure while receiving nor triptyline and oxazepam. Because of known respiratory depressant effec ts of the latter drug, nortriptyline alone was resumed upon recovery. Depression of CO2 sensitivity and ventilatory load compensation with a concomitant increase in exercise tolerance with decreased dyspnea was observed while she was receiving nortriptyline. These results demonst rate a previously unreported depressant effect of nortriptyline on ven tilatory control, and they suggest the need for further investigation of the ventilatory effects of this drug in patients with pulmonary dis ease.