ABSTRACT
Although medications can potentially cause sudden, unexpected death by a variety of mechanisms, cardiac arrhythmias are the most frequent cause. Reports of sudden deaths of children and adolescents treated with psychotropic medications have raised concerns regarding the appropriateness of this therapy, as well as the advisability of baseline and periodic electrocardiographic monitoring of such patients. Stimulants such as the amphetamines and methylphenidate cause slight but clinically insignificant increases in heart rate and blood pressure. The tricyclic antidepressants imipramine and desipramine have been associated with at least seven reported deaths in young patients. The selective serotonin reuptake inhibitors have minimal cardiovascular effects; deaths have been rare, even with massive overdose.
