Use of desipramine in the medically ill.

The use of desipramine in treating major depressive disorder in the hospitalized medically ill patient is described. Desipramine has a low incidence of anticholinergic side effects, causes little orthostatic hypotension, and has a quinidine-like effect on cardiac arrhythmias. Desipramine should be used with caution in patients with risk of heart block and bundle branch block. Guidelines for administration of desipramine in the medically ill are discussed, and drug interactions with medications commonly used in this population are reviewed. Finally, the importance of providing psychotherapy along with desipramine treatment in treating the medically ill depressed patient is emphasized.