QTc changes and early major adverse cardiovascular events associated with antidepressant treatment for major depressive disorder in adults: individual participant data network meta-regression of double blind randomised trials

The study compared the effect of various antidepressants with placebo on the heart rate corrected QT interval (QTc) during the first eight weeks of depression treatment in adults. The analysis included data from 35 randomized trials with 8679 participants. Escitalopram and amitriptyline were associated with QTc prolongation (8.7 and 5.3 milliseconds compared to placebo, respectively). Amitriptyline showed the highest QTc prolongation in 58.8% of cases, while venlafaxine and vortioxetine were associated with the lowest values. Analysis of 139 trials with 52,398 participants did not demonstrate increased risk of major adverse cardiovascular events with antidepressant use compared to placebo. The results suggest that individual patient risk factors should be considered when selecting antidepressants.