CARDIOVASCULAR EFFECTS OF TRICYCLIC ANTIDEPRESSANTS IN CHILDHOOD ASTHMA - A CASE SERIES AND REVIEW

Children with asthma frequently have significant anxiety and depressio n that interfere with treatment outcome. Although the use of antidepre ssants may be helpful, in the one published study of antidepressant us e in pediatric asthma, significant side effects necessitated discontin uance; these side effects were increased motor activity, impulsive beh avior, insomnia, postural hypotension, premature auricular contraction s, diastolic hypertension, and generalized seizure. The objective of t his retrospective chart review was to examine whether antidepresants c ould be tolerated and administered safely to children on asthma medica tions. Forty pediatric inpatients (mean age 13.3 years, range 7-19) wi th varying levels of asthma severity (5 mild, 11 moderate, 24 severe) and an average duration of asthma treatment of 10.0 years were adminis tered antidepressants while also taking an average of 5 medications fo r asthma (range 2-7). Ten of the patients had an additional comorbid m edical diagnosis. There were 17 children diagnosed with a primary affe ctive, disorder; 7 with a primary anxiety disorder; and 16 with both a n affective and anxiety disorder. Thirty-six children ultimately were continued on an antidepressant: 13 on desipramine, 9 on nortriptyline, 6 on imipramine, 4 on fluoxetine, 3 on bupropion, and 1, on sertralin e. Significant cardiovascular side effects (tachycardia, hypertension, and postural hypotension) occurred in 4 subjects on tricyclic antidep ressants (TCAs) and 1 subject on a non-TCA (fluoxetine); 3 of these su bjects were able to continue treatment with an antidepressant. Two sub jects were taken off antidepressants because of hypomanic symptoms (in creased motor activity, mood lability, impulsive behavior, and insomni a). No medications were discontinued because of electrocardiogram chan ges, arrhythmias, or seizures. Doses of TCAs were comparable to those in previous studies, but the asthma medications differed. Discussion o f current anti-asthmatic medications and potential for interactions wi th antidepressants is included.