May 13, 2015British Journal of Clinical PharmacologyOpen Access

Use of selective serotonin re‐uptake inhibitors and the heart rate corrected QT interval in a real‐life setting: the population‐based Rotterdam Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: QTc prolongation (n=12589). Intervention: Selective serotonin re-uptake inhibitors (SSRIs), specifically citalopram vs. Non-use of any antidepressant. Primary outcome: Difference in heart rate corrected QT interval (QTcF) (MD 12.8 ms, 95% CI 7.5-18.2).

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Key result

Citalopram is linked to a ~13 ms longer QTcF versus non-use, despite no SSRI class effect.

MD 12.8 ms
95% CI 7.5-18.2
n=12,589

Why the study?

Does the use of SSRIs increase QTcF in older adults?

Population

12,589 adults from the prospective population-based Rotterdam Study with up to 5 ECGs.

Comparison

Selective serotonin re-uptake inhibitors as a… vs Non-use of any antidepressant.

Design

Cohort

Follow-up

median 4.3 years between consecutive visits

Authors

NMNevena MaljurićUniversity of Belgrade RNRaymond NoordamGeneral / Preventive / Lipids NANikkie AartsErasmus MC

Discussion

Member takes

Implication

Citalopram may warrant QTc monitoring in older adults even at ≤20 mg; leaves open whether other SSRIs confer clinically relevant risk.

Study Design

Type

Observational (n=12,589)

Structured PICO

Does the use of SSRIs increase QTcF in older adults?

Population

12,589 middle-aged and older adults (mean age 65.2 years) from the population-based Rotterdam Study with up to five ECG measurements to assess QTc prolongation.

Exposure

Selective serotonin re-uptake inhibitors (SSRIs) as a class and individually (citalopram, paroxetine, fluoxetine, sertraline, fluvoxamine, escitalopram).

Comparator

Non-use of any antidepressant.

Outcome

QTcF (QT corrected according to Fridericia) measured during use of SSRIs compared with non-use.surrogate

Main Result

Mean Difference: 12.8 (95% CI 7.5–18.2)

Citalopram use is associated with clinically relevant QTcF prolongation, even at restricted doses of ≤20 mg/day in older adults, whereas other SSRIs do not show a clinically relevant class effect.

Limitations

Low number of users for some individual SSRIs, preventing dose-response analyses.
Long median time period (4.3 years) between consecutive ECG recordings, meaning acute effects cannot be ruled out.
Observational, non-randomized design is subject to potential residual confounding.
Low numbers of users for some individual SSRIs preventing dose-response analyses
Long median time period (4.3 years) between consecutive ECGs, meaning acute effects cannot be ruled out
Non-randomized observational design subject to residual confounding

Cite This Study

Maljurić et al. (2015) conducted an observational in QTc prolongation (n=12,589). Selective serotonin re-uptake inhibitors (SSRIs), specifically citalopram vs. Non-use of any antidepressant was evaluated on Difference in heart rate corrected QT interval (QTcF) (MD 12.8 ms, 95% CI 7.5-18.2). While no overall SSRI class effect was observed, use of citalopram was associated with a 12.8 ms longer QTcF compared to non-use of antidepressants.

synapsesocial.com/papers/6aa14a2ed197d8a43ced6a85 https://doi.org/10.1111/bcp.12681

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May 13, 2015British Journal of Clinical PharmacologyOpen Access

Use of selective serotonin re‐uptake inhibitors and the heart rate corrected QT interval in a real‐life setting: the population‐based Rotterdam Study

View Full Paper

Ask AI

Bookmark

Key result

Citalopram is linked to a ~13 ms longer QTcF versus non-use, despite no SSRI class effect.

MD 12.8 ms
95% CI 7.5-18.2
n=12,589

Why the study?

Does the use of SSRIs increase QTcF in older adults?

Population

12,589 adults from the prospective population-based Rotterdam Study with up to 5 ECGs.

Comparison

Selective serotonin re-uptake inhibitors as a… vs Non-use of any antidepressant.

Design

Cohort

Follow-up

median 4.3 years between consecutive visits

Authors

NMNevena MaljurićUniversity of Belgrade RNRaymond NoordamGeneral / Preventive / Lipids NANikkie AartsErasmus MC

Discussion

Member takes

Implication

Citalopram may warrant QTc monitoring in older adults even at ≤20 mg; leaves open whether other SSRIs confer clinically relevant risk.

Study Design

Type

Observational (n=12,589)

Structured PICO

Does the use of SSRIs increase QTcF in older adults?

Population

12,589 middle-aged and older adults (mean age 65.2 years) from the population-based Rotterdam Study with up to five ECG measurements to assess QTc prolongation.

Exposure

Selective serotonin re-uptake inhibitors (SSRIs) as a class and individually (citalopram, paroxetine, fluoxetine, sertraline, fluvoxamine, escitalopram).

Comparator

Non-use of any antidepressant.

Outcome

QTcF (QT corrected according to Fridericia) measured during use of SSRIs compared with non-use.surrogate

Main Result

Mean Difference: 12.8 (95% CI 7.5–18.2)

Citalopram use is associated with clinically relevant QTcF prolongation, even at restricted doses of ≤20 mg/day in older adults, whereas other SSRIs do not show a clinically relevant class effect.

Limitations

Low number of users for some individual SSRIs, preventing dose-response analyses.
Long median time period (4.3 years) between consecutive ECG recordings, meaning acute effects cannot be ruled out.
Observational, non-randomized design is subject to potential residual confounding.
Low numbers of users for some individual SSRIs preventing dose-response analyses
Long median time period (4.3 years) between consecutive ECGs, meaning acute effects cannot be ruled out
Non-randomized observational design subject to residual confounding

Cite This Study

synapsesocial.com/papers/6aa14a2ed197d8a43ced6a85 https://doi.org/10.1111/bcp.12681

Also Consider

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