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2013-01-30 12:46:57
Some but not all antidepressant drugs known as SSRIs pose a very small but
serious heart risk, say researchers.
Citalopram and escitalopram, which fall into this drug group, can trigger a
heart rhythm disturbance, a new study in the British Medical Journal shows.
UK and US regulators have already warned doctors to be extra careful about
which patients they prescribe these medicines to.
And they have lowered the maximum recommended dose.
The UK's Medicines and Healthcare products Regulatory Agency (MHRA) says people
with pre-existing heart conditions should have a heart trace before going on
these drugs, to check for a rhythm disturbance known as long QT interval.
Start Quote
People taking these drugs shouldn't be alarmed and shouldn't stop taking their
medication without speaking to their doctor
June Davison of the British Heart Foundation
Experts reassure that complications are very rare and that in most cases the
benefits for the patient taking the drug will outweigh the risks.
Long QT
QT interval is measured with an electrocardiogram (ECG) and varies with the
heart rate - it gets longer when the heart beats slower and is shorter when the
heart beats faster.
Some variation is normal, but if it gets too long it can upset the timing of
heartbeat with potentially dire consequences - dizziness, faints and, rarely,
sudden death.
To assess how common a problem long QT linked to SSRI use might be, US
researchers decided to look at the medical records of more than 38,00 patients
from New England.
Most of these patients had been prescribed an SSRI antidepressant, and some
were patients who had been prescribed methadone. The researchers included the
methadone patients for comparison because this drug (used for pain relief and
to wean addicts off heroin) is known to prolong QT interval.
All of the patients had recently had an ECG.
Both citalopram and escitalopram, as well as methadone, was linked with a small
but significantly longer QT interval.
This effect increased at higher doses.
Risks vs benefits
But the researchers say that while longer QT interval is a risk factor for
abnormal heart rhythms, these abnormal rhythms are still extremely rare, and
the actual increase in QT observed was modest - so for the vast majority of
patients, the potential benefits in treating depression or anxiety would far
exceed the risk.
June Davison of the British Heart Foundation said: "Having a long QT interval
can potentially increase the risk of a serious abnormal heart rhythm. However,
as these abnormal rhythms are very rare, the potential benefits in treating
depression would exceed the risk for most patients.
"People taking these drugs shouldn't be alarmed and shouldn't stop taking their
medication without speaking to their doctor. If you've got any concerns, speak
to your GP or pharmacist."
A spokesman for the MHRA said: "The potential risks associated are well known
and restrictions have been placed on the level of dosage for particular groups
of patients.
"This report acknowledges that the benefits of this medicine outweighs the
risks but it is important that these factors are carefully considered by
healthcare professionals for patients with pre-existing health conditions such
as certain heart conditions."
Helen Williams, from the Royal Pharmaceutical Society, said: "Patients should
be reassured that the effects on QT noted by the study researchers were small
and the risk of any adverse outcome associated with these changes is very low.
"The study results may however assist clinicians distinguish between different
antidepressants drugs when prescribing - choosing a lower risk agent for
patients where there is an established increased risk of arrhythmias."