Antidepressants and cardiac safety

AI Summary

Antidepressants, previously considered safe regarding cardiac effects, are now studied for potential risks of QTc prolongation and ventricular arrhythmias. Evidence on their cardiac safety is mixed, leaving prescribers with conflicting data on risk stratification for drugs like SSRIs and citalopram.

The potential for QTc prolongation and ventricular arrhythmias is a major concern when prescribing psychiatric drugs, including antidepressants.Although antipsychotics had been associated with QTc prolongation for many years, most antidepressants, including selective serotonin reuptake inhibitors (SSRIs), were largely considered safe until regulatory warnings for citalopram were issued after a thorough QT study.1 Similar warnings for escitalopram followed in some countries, including the UK.2 Since then, many studies have examined whether antidepressants prolong the QTc interval and increase risk for torsades de pointes, although data on individual agents, extent of QTc prolongation, and actual risk of arrhythmias or sudden cardiac death remain mixed.3456 Prescribers are left with conflicting evidence about risk stratifying antidepressants, not only for QTc prolongation, but, more importantly, for cardiac safety in patients in the real world setting.3The linked individual participant data network meta-regression of double blind, randomised trials by Ostinelli and colleagues (doi:10.1136/bmj-2026-100600) is a welcome addition...