Treatment of depressive states ...

Treatment of depressions formed in patients with coronary artery disease can be quite a challenge. One of its most important aspects - the need to choose the safest antidepressant that has minimal "cardiotoxicity" (the potential for adverse effects of the drug on the cardiovascular system). Thus, one of a fairly common side effects that occur in the appointment of tricyclic antidepressants, TCAs, selective norepinephrine reuptake inhibitors / antagonists of noradrenaline [17.33], is orthostatic hypotension. The latter can lead to the development of collapse associated with risk of injury (fractures, dislocations), myocardial infarction or even sudden death [31.35]. Orthostatic hypotension may develop in persons of any age, but the greatest risk are elderly patients [32]. It should be borne in mind that some antidepressants can cause increased blood pressure. So described, at least ten cases of hypertensive reactions when receiving a reversible inhibitor of monoamine oxidase type A - moclobemide [20,21]. Many antidepressants have independent clinically significant effect on heart rhythm. Among the most common and relatively benign effects of TCAs - sinus tachycardia due to anticholinergic effects and are observed in patients without concomitant diseases of the cardiovascular system, and in patients with cardiac rhythm disturbances [34]. In the latter case, you should take special care when assigning TCAs and maprotiline, because the effect of drugs on these groups timoleptikov conducting system of the heart comparable with the action of antiarrhythmic drugs of class I A (quinidine, novokainamid, etc.) [10,11,12]. Among timoleptikov apparently having no cardiotoxicity, in-depth consideration deserves Pirazidol. Antidepressant, even in very high doses has no effect on myocardial contractility [26], does not cause orthostatic hypotension phenomena [4,5,33], virtually no effect on the rhythm of the heart and vascular system and does not alter the picture of the ECG [9]. Moreover, some of the effects Pirazidola in its application in patients with coronary artery disease may even be regarded as therapeutically desirable. In particular, experimental studies have shown the protective properties of an antidepressant in a tissue hypoxia caused by blood circulation [1,3]. Pirazidol, appear to favorably affect the course of angina pectoris [18]. It should also be noted that there are no published data on adverse drug interactions between Pirazidolom and cardiotropic agents [7]. Obviously, this is because Pirazidol no significant effect on the activity of isoenzymes of the liver involved in the metabolism of most drugs [1]. Thus, it seems appropriate to explore the therapeutic efficacy and safety of the drug in the treatment of depression in patients with coronary artery disease.