Key result
Antidepressant use linked to ~62% higher all-cause mortality in adults with mental disorders.
Why the study?
Drug-induced QT prolongation is associated with higher cardiovascular mortality.
Do antidepressants increase the risk of QT prolongation, torsades de pointes, and sudden death in people with mental disorders?
Meta-Analysis (n=1,716,552)
Do antidepressants increase the risk of QT prolongation, torsades de pointes, and sudden death in people with mental disorders?
Antidepressants, particularly SSRIs and high-dose tricyclics, are associated with an increased risk of QT prolongation and sudden death, necessitating ECG monitoring and adherence to licensed doses.
Answers are grounded in this paper and cite their sources.
May warrant prescribing caution and ECG monitoring in mental disorders; leaves open need for RCTs to confirm mortality link.
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 RESULTS: Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used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.
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Aronow et al. (2020) conducted a meta-analysis in Mental disorders (n=1,716,552). Antidepressants vs. No antidepressants or placebo was evaluated on All-cause mortality (RR 1.62, 95% CI 1.60-1.63). Antidepressant use was associated with increased all-cause mortality (RR 1.62) compared to no antidepressant use in adults with mental disorders.
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