Key features of depression and its management in general practice.
 
  "..Everything is ok in
that department.."

In considering alternate treatments, which of the following statements are true of antidepressants treatment and electroconvulsive therapy (ECT) in this context?
1. Tricyclic antidepressants cause orthostatic hypotension.
2. Tricyclic antidepressants are recommended for people with ischaemic heart disease.
3. The adverse effects of SSRIs usually settle within the first one or two weeks of treatment.
4. If adverse effects are persistent, it is best to switch to another class of antidepressants.
5. Patients with cardiac disease are at increased risk of cardiovascular complications during ECT.
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5. Patients with cardiac disease are at increased risk of cardiovascular complications during ECT.

Author's answer: True

Available information suggests that patients with cardiac disease are more likely to experience cardiovascular complications during ECT than patients without heart disease. During ECT, heart rate and blood pressure increase substantially, followed by a vagally mediated bradycardia. Patients with ischemic heart disease or ventricular arrhythmias are at increased risk of myocardial infarction or ventricular tachyarrhythmias. Most complications are transient, however, and do not necessarily preclude use of this modality.