Antidepressants and cardiac safety

Antidepressants pose a potential risk of QTc interval prolongation and ventricular arrhythmias, which is a major concern when prescribing them. They were long considered safe, particularly selective serotonin reuptake inhibitors (SSRIs), until regulatory warnings were issued for citalopram following a QT study. Similar warnings subsequently followed for escitalopram in some countries including the United Kingdom. Since then, many studies have examined whether antidepressants prolong the QTc interval and increase the risk of torsades de pointes, however data on individual drugs, the extent of QTc prolongation, and the actual risk of arrhythmias or sudden cardiac death remain inconsistent. Clinicians face conflicting evidence when stratifying the risk of antidepressants not only for QTc prolongation, but most importantly for cardiac safety in patients in real-world clinical settings.