What is a major contraindication for the use of tricyclic antidepressants?

The use of tricyclic antidepressants (TCAs) is contraindicated in individuals with a recent myocardial infarction because these medications can negatively impact cardiac function. TCAs can cause increased heart rate, orthostatic hypotension, and even arrhythmias due to their anticholinergic properties and effects on cardiac conduction. This makes them potentially dangerous for patients who have recently suffered a heart attack, as their cardiovascular system is already compromised.

While glaucoma, hypertension, and severe asthma may present challenges in terms of potential drug interactions or effects, they do not classify as absolute contraindications in the same way a recent myocardial infarction does. For example, some tricyclics may exacerbate narrow-angle glaucoma due to their anticholinergic effects, but this is generally a concern to be monitored rather than an outright prohibition. Similarly, hypertension can be managed with careful monitoring and dose adjustments, and while asthma is a concern due to possible respiratory side effects, it is not a direct contraindication either.