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—We agree with Dr DiFilippo that tricyclic antidepressants, such as protriptyline, are used to stimulate ventilation in patients with sleep apnea. Our statement that "To our knowledge, hyperventilation induced by use of the tricyclic antidepressants, particularly nortriptyline, has not been reported in the literature" is made with reference to severe life-threatening hyperventilation requiring mechanical ventilation support and paralysis. We also agree with Dr DiFilippo that tricyclic antidepressants, such as nortriptyline, should be added to the list of drugs that potentially can stimulate ventilation.
SUNDERRAJAN S, Brooks CS, SUNDERRAJAN EV. Nortriptyline and Protriptyline in Hyperventilation-Reply. Arch Intern Med. 1985;145(9):1736. doi:10.1001/archinte.1985.00360090212037