Effects of antidepressants on QT interval in people with mental disorders

Abstract

Introduction

Drug-induced QT prolongation is associated with higher cardiovascular mortality.

Material and methods

We conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders.

Results

Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used only with licensed doses, and that all patients receiving antidepressants require monitoring of QT prolongation and clinical symptoms of cardiac arrhythmias. Large observational studies suggest increased mortality associated with all antidepressants (RR = 1.62, 95% CI: 1.60–1.63, number of adults: 1,716,552), high doses of tricyclic antidepressants (OR = 2.11, 85% CI 1.10–4.22), selective serotonin reuptake inhibitors (OR = 2.78, 95% CI: 1.24–6.24), venlafaxine (OR = 3.73, 95% CI: 1.33–10.45, number of adults: 4,040), and nortriptyline (OR = 4.60, 95% CI: 1.20–18.40, number of adults: 5,298).

Conclusions

Evidence regarding the risk of QT prolongation in children is sparse.