Cardiovascular effects of tricyclic and tetracyclic antidepressants.

This article reviews all available studies on the cardiovascular effects of tri- and tetracyclic antidepressants at therapeutic and toxic levels. There is growing evidence that tricyclics, even at therapeutic levels, can be cardiotoxic. Plasma TCA levels are too variable to define a safe therapeutic range. Any patient showing cardiovascular side effects should have an ECG before continuing medication.