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May 15, 2014The Journal of Clinical Psychiatry

Meta-Analysis of Selective Serotonin Reuptake Inhibitor–Associated QTc Prolongation

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Why the study?

Do selective serotonin reuptake inhibitors (SSRIs) increase QTc prolongation compared to placebo or TCAs in adult patients?

Population

4,292 adult patients from 16 prospective controlled studies (25 distinct data subsets)

Comparison

Selective serotonin reuptake inhibitors as a class vs Placebo or tricyclic antidepressants (TCAs)

Design

Meta-analysis

Authors

SBScott R. BeachMassachusetts General HospitalWKWilliam J. KostisElectrophysiologyCCChristopher M. CelanoPreventive Cardiology

Discussion

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Implication

Supports QTc monitoring with higher-dose SSRIs in at-risk patients; extends evidence by quantifying effects versus TCAs.

Structured PICO

Do selective serotonin reuptake inhibitors (SSRIs) increase QTc prolongation compared to placebo or TCAs in adult patients?

P
Population
4,292 adult patients from 16 prospective controlled studies (25 distinct data subsets)
I
Intervention
Selective serotonin reuptake inhibitors (SSRIs) as a class (including citalopram, escitalopram, fluoxetine, sertraline, paroxetine, and fluvoxamine)
C
Comparator
Placebo or tricyclic antidepressants (TCAs)
O
Outcome
Corrected QT interval (QTc) prolongationsurrogate

SSRIs are associated with a modest, dose-dependent increase in the QTc interval compared to placebo, with citalopram causing more prolongation than other SSRIs, though the overall effect is smaller than that of TCAs.

Cite This Study

Beach et al. (2014) studied this question.

synapsesocial.com/papers/6a724aee5d37378ac1df2102https://doi.org/10.4088/jcp.13r08672
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Use of selective serotonin re‐uptake inhibitors and the heart rate corrected QT interval in a real‐life setting: the population‐based Rotterdam Study2015 · 43 citations
  2. 2A Comparison of the Risk of QT Prolongation Among SSRIs2013 · 175 citations
  3. 3QT interval and antidepressant use: a cross sectional study of electronic health records2013 · 312 citations
  4. 4A Systematic Evaluation of the QTc Interval and Antidepressants in Youth2015 · 17 citations
  5. 5An analysis of QTc prolongation with atypical antipsychotic medications and selective serotonin reuptake inhibitors using a large ECG record database2016 · 10 citations