PVC's while on Imipramine

Posted By Joe on July 28, 1998 at 01:35:02:







I am a 43 yr. old male who for the past 20 yrs. has been diagnosed and treated successfully for repeated episodes of endogenos depression. The drug that works the best for my depression is imipramine (Tofranil). Over the yrs. I was able to manage lasting remission of the depressive episodes by staying on small, (50mg. 1 per day) dosages. The imipramine has always caused its routine side effects of dry mouth, sweating, tachycardia, etc, but these have never been a problem in comparison to the excellent effect for the depressive disorder. As I rounded the corner of 40 yrs. of age I have experienced a rise in the depressive episodes and have had to move to higher dosages of the imipramine in order to control them (50mg. 3per day). This is managing the deprssive symtoms (symptoms) perfectly , but there is also more discomfort from the side effects of the drug. In particular, this time, it's PVC's. Now over the years, while on this medication, I have always had some here or there, couplets, triplets, etc. After extensive testing, (24hr.Holter Monitor, Echocariogram, EKG). None of these tests posed a serious concern to my internist/cardiologist, who has patiently put up with 20 yrs. of depressive/anxiety symtoms (symptoms) manufactured by my sometimes missfiring braincells! However, over the past 2 months it seems that this bout of "irritable heart syndrom (syndrome)"-(what I call it)-contains long groups of skipped beats than I have ever experienced before, sometimes 8 or 10 at a time before my "norm" (100-110) kicks in. Now I have absolutely no "feeling" of this, in fact I feel great! No swollen ankles, no fatigue, lack of energy,etc. But every once in a while, particularly when relaxing, I'll become aware that my heart is not romping at its usual tachycardic clip. What's going on ? Incidently, when this current barrage began 2 months ago, I immediatly had my cardiologist do another EKG, and he seemed not concerned. One last item, you're probably thinking, why not chuck the Tofranil for the newer designer SSRI's. Well, I did too, tried 3 yrs. ago, Paxil is great for me if I'm constipated, or if I like to experience "barrel-rolling" dizzyness while my depressive symtoms (symptoms) rage on. Should I continue to worry about these PVC's and press for more testing or let more time pass to see if the whole mess just clears up ? Could my AV nodes be damaged ? Wouldn't tests see something like this immediatly ?