Effects of antidepressants on QT interval in people with mental disorders

Aronow, Wilbert S.; Shamliyan, Tatyana

doi:10.5114/aoms.2019.86928

Cited by 14 publications

(28 citation statements)

References 117 publications

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“…The risk of QTc prolongation and associated tachyarrhythmia is likely to be greater in the elderly, in patients with cardiovascular and other co-morbidity and in those on other pharmacotherapy, especially polypharmacy (Franchi et al, 2016). It is suggested that all antidepressants may carry this risk and that therefore QTc and clinical symptoms of arrhythmia should be monitored for all antidepressants (Aronow and Shamliyan, 2020). There is debate regarding whether particular agents are more problematic in this regard.…”

Section: Complex Presentations and Special Populationsmentioning

confidence: 99%

“…Among second generation antidepressants, it has been suggested that citalopram and escitalopram are differentially associated with QTc prolongation and arrhythmias (Qirjazi et al, 2016). However, it has been suggested that this risk exists also with other antidepressants (Aronow and Shamliyan, 2020). Where antidepressants are to be used in higher than standard doses in the elderly, baseline and steady state QTc monitoring is recommended.…”

Section: Complex Presentations and Special Populationsmentioning

confidence: 99%

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The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

322

365

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Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

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Section: Complex Presentations and Special Populationsmentioning

confidence: 99%

Section: Complex Presentations and Special Populationsmentioning

confidence: 99%

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

322

365

View full text Add to dashboard Cite

show abstract

“…Antipsychotic and antiepileptic medications have been reported to have a range of cardiac side-effects, including orthostatic hypotension [ 43 ], cardiomyopathy [ 44 ], QT prolongation [ 45 ] and increased risk for SCD [ 9 ]. Moreover, antidepressant drugs have been associated with adverse cardiac effects: the selective serotonin reuptake inhibitors (SSRIs) and particularly the tricyclic antidepressants are known to cause prolongation of the heart rate corrected QT interval (QT c ) on an ECG and predispose to ventricular arrhythmias [ 46 , 47 ]. These cardiotoxic effects of psychiatric disorder therapeutics are of particular importance in patients with an underlying CVD.…”

Section: Psychiatric Disorders and Cardiovascular Diseasesmentioning

confidence: 99%

Neurological Disorders and Risk of Arrhythmia

Bernardi

Aromolaran

2020

IJMS

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Neurological disorders including depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, autism and epilepsy are associated with an increased incidence of cardiovascular disorders and susceptibility to heart failure. The underlying molecular mechanisms that link neurological disorders and adverse cardiac function are poorly understood. Further, a lack of progress is likely due to a paucity of studies that investigate the relationship between neurological disorders and cardiac electrical activity in health and disease. Therefore, there is an important need to understand the spatiotemporal behavior of neurocardiac mechanisms. This can be advanced through the identification and validation of neurological and cardiac signaling pathways that may be adversely regulated. In this review we highlight how dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis, autonomic nervous system (ANS) activity and inflammation, predispose to psychiatric disorders and cardiac dysfunction. Moreover, antipsychotic and antidepressant medications increase the risk for adverse cardiac events, mostly through the block of the human ether-a-go-go-related gene (hERG), which plays a critical role in cardiac repolarization. Therefore, understanding how neurological disorders lead to adverse cardiac ion channel remodeling is likely to have significant implications for the development of effective therapeutic interventions and helps improve the rational development of targeted therapeutics with significant clinical implications.

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“…A systematic review of non-cardiac patients found observational low-quality studies reporting evidence of increased sudden death associated with higher doses of tricyclic anti-depressants and specific selective serotonin and norepinephrine reuptake inhibitors such as venlaxafine. In addition, they reported an increase in the risk of all-cause mortality in patients taking anti-depressants that prolong the QT interval [52]. HF patients are frequently prescribed anti-arrhythmics and are at risk of polypharmacy and of electrolyte disturbances, which may further increase the risk of potentially lethal arrhythmias in the setting of anti-depressant therapy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression

Zwas

Keren

Amir

et al. 2020

JCM

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Background: Few studies have evaluated the effect of pharmacologic treatment of anxiety on outcomes in heart failure (HF) patients. This study examined the impact of treatment with anxiolytics on clinical outcomes in a real-world sample of HF patients with and without depression. Methods: Patients diagnosed with HF were retrieved from a large HMO database. Patients prescribed anxiolytic medication and patients diagnosed with depression and/or prescribed anti-depressant medication were followed for cardiac-related hospitalizations and death. Results: The study cohort included 6293 HF patients. Treatment with anxiolytics was associated with decreased one-year survival compared to untreated individuals, with a greater reduction in survival seen in patients diagnosed with depression and/or treated with anti-depressants. Multi-variable analysis adjusting for age, sex, NYHA class, cardiac risk factors and laboratory parameters found that treatment with anxiolytics remained a predictor of mortality even when adjusting for depression. Depression combined with anxiolytic treatment was predictive of increased mortality, and treatment with anxiolytics alone, depression alone and anxiolytic treatment together with depression were each associated with an increased hazard ratio for a composite outcome of death and hospitalization. Conclusions: In this real-world study of HF patients, both treatment with anxiolytics and depression were associated with increased mortality, and anxiolytic therapy remained a predictor of mortality when adjusting for depression. Treatment of anxiety together with depression was associated with the highest risk of mortality. Safe and effective treatment for anxiety and depression is warranted to alleviate the detrimental impact of these disorders on quality and of life and adverse events.

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Effects of antidepressants on QT interval in people with mental disorders

Cited by 14 publications

References 117 publications

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Neurological Disorders and Risk of Arrhythmia

Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression

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