Key result
Lithium augmentation shows no effect on HR or QTc but is linked to T-wave alterations.
Why the study?
Lithium has been linked to cardiovascular adverse effects including QTc prolongation and tachyarrhythmia, but previous studies investigated monotherapy rather than lithium augmentation of antidepressants.
Does lithium augmentation of antidepressants cause serious electrocardiographic abnormalities in patients with major depressive disorder?
Observational (n=38)
Does lithium augmentation of antidepressants cause serious electrocardiographic abnormalities in patients with major depressive disorder?
Lithium augmentation of antidepressants does not appear to cause serious ECG abnormalities such as QTc prolongation at therapeutic serum levels.
May support QTc safety of lithium augmentation; leaves open relevance of T-wave changes pending larger studies.
PURPOSE/BACKGROUND: Lithium augmentation of antidepressants represents a common strategy to overcome treatment resistance in patients with major depressive disorder. The use of lithium has been associated with cardiovascular adverse effects such as QTc prolongation and tachyarrhythmia. Although the previous studies investigated monotherapy with lithium, the aim of this study was to investigate electrocardiographic changes in LA. METHODS/PROCEDURES: A 12-lead surface electrocardiogram (ECG) was obtained from 38 patients with major depressive disorder before and during LA. Changes in heart rate, PQ, QRS and QTc interval, QT dispersion, ST segment, and T- and U-wave alterations were analyzed using a linear mixed model. FINDINGS/RESULTS: The ECG readings of 33 patients were evaluated. Lithium augmentation was not significantly associated with changes in heart rate, QTc, PQ, or QRS interval. We found a significant decrease in QT dispersion. These results were independent of sex, age, stable comedication, and comorbidities. During LA, we observed 9 cases of T-wave alterations and 2 cases of new U waves. CONCLUSIONS: Our data provide no evidence for serious ECG abnormalities at therapeutic serum lithium levels in patients treated with LA. In particular, we did not find evidence for QTc time lengthening or tachyarrhythmia, such as torsades des pointes. The recommended intervals for ECG checks should be considered to detect long-term effects of LA.
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A 2021 study conducted an observational in Major depressive disorder (n=38). Lithium augmentation vs. Baseline (before lithium augmentation) was evaluated on Changes in heart rate, PQ, QRS and QTc interval, QT dispersion, ST segment, and T- and U-wave alterations. Lithium augmentation was not associated with significant changes in heart rate or QTc interval, but resulted in 9 cases of T-wave alterations and 2 cases of new U waves among 33 evaluated patients.
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