Abstract
IntroductionDrug-induced QT prolongation is associated with higher cardiovascular mortality.Material and methodsWe conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders.ResultsBased on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used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).ConclusionsEvidence regarding the risk of QT prolongation in children is sparse.
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