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AD Contribution to Arrhythmia Risk Clarified


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http://www.sciencedaily.com/releases/2013/01/130129190237.htm

 

Jan. 29, 2013 — A 2011 warning from the U.S. Food and Drug Administration about the popular antidepressant citalopram (Celexa) left many patients and physicians with more questions than answers. Now an analysis of the medical records of more than 38,000 patients by Massachusetts General Hospital (MGH) investigators clarifies the contribution of citalopram and other antidepressants to lengthening of the QT interval, an aspect of the heart's electrical activity that -- when prolonged -- may increase the risk of dangerous arrhythmias. The study supported the FDA's warning that higher doses of citalopram were associated with a prolonged QT interval but also found that the effects of some other antidepressants were quite different.

 

"It was important to confirm the effects of citalopram -- one of the most widely prescribed antidepressants in the U.S. -- because the FDA warning really gave us minimal clinical guidance," says Roy Perlis, MD, of the MGH Department of Psychiatry, corresponding author of the report that will appear in the journal BMJ and is being released online. "The impetus for this study came directly from the phone calls we received from colleagues and from patients taking citalopram asking what they should do. We realized that to get a satisfying answer, we needed to get more data."

 

Many medications -- including some older antidepressants -- are known to increase the QT interval, which is the time from the beginning of electrical activation of the heart to the end of electrical relaxation. While the vast majority of individuals with QT prolongation have no heart rhythm abnormalities, it is a recognized risk factor for a rare but dangerous arrhythmia called torsades de pointes. To get a better idea of the real-world prevalence of QT prolongation associated with citalopram and other antidepressants, the MGH team embarked on an analysis of the medical records of thousands of patients treated at the MGH and other Partners HealthCare facilities.

"We are fortunate that our colleagues at MGH and Partners have developed incredibly useful tools to answer specific questions by rapidly and simultaneously looking across electronic health record data from tens of thousands of patients while protecting patient confidentiality," Perlis explains. "Working with them we developed a way to look at each EKG report and pull out QT interval information and other relevant results. Doing this by hand -- flipping through individual patient charts -- would have taken a year or more. Doing it with electronic health records took about an hour."

 

The study examined the health records of 38,397 patients who had an EKG reading taken at a Partners facility between 14 and 90 days after receiving a prescription for one of 11 different antidepressant drugs or for methadone, which is known to prolong QT interval. Their analysis confirmed the association of a slight but significant QT prolongation with higher doses of citalopram, along with the known associations with methadone and with the older antidepressant amitriptyline. The results also associated QT prolongation with the newer antidepressant escitalopram (Lexapro); but many other drugs -- including fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) -- had no effect on QT interval. The antidepressant bupropion (Wellbutrin/Zyban) was actually associated with shortening the QT interval.

 

Perlis cautions that the results of this study should not cause patients taking citalopram or escitalopram to stop taking their medication. "I worry more about people stopping their antidepressants unnecessarily than about the QT prolongation risks," he explains. "For patients starting a new antidepressant who have other risk factors for arrhythmias, a drug other than citalopram would probably be a wise choice. But for those already taking lower doses of either of these drugs, the QT prolongation effects seem to be modest. The real message to patients taking these drugs is to have a conversation with their doctors."

 

The speed with which the investigators were able to complete their study reflects the power of electronic health record analysis to answer important research questions, he adds. "Finding the QT-shortening effects of bupropion shows how this approach can help us find drugs with unexpected benefits and not just unexpected problems. As long as we're willing to accept the limitations -- particularly the fact that people aren't randomly assigned to different treatments -- this strategy allows us to study many more patients and get answers much faster. In terms of patient privacy, this is actually much safer than the older methods, which required a person to look through a pile of medical records one by one. This way we only extract the data we need and never see anything that would allow us to identify an individual patient." Perlis is an associate professor of Psychiatry at Harvard Medical School.

 

Massachusetts General Hospital (2013, January 29). Antidepressant contribution to arrhythmia risk clarified. ScienceDaily. Retrieved January 30, 2013, from http://www.sciencedaily.com­ /releases/2013/01/130129190237.htm

Edited by Altostrata
added source

Everything Matters: Beyond Meds 

https://beyondmeds.com/

withdrawn from a cocktail of 6 psychiatric drugs that included every class of psych drug.
 

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Perlis cautions that the results of this study should not cause patients taking citalopram or escitalopram to stop taking their medication. "I worry more about people stopping their antidepressants unnecessarily than about the QT prolongation risks," he explains. "For patients starting a new antidepressant who have other risk factors for arrhythmias, a drug other than citalopram would probably be a wise choice. But for those already taking lower doses of either of these drugs, the QT prolongation effects seem to be modest. The real message to patients taking these drugs is to have a conversation with their doctors."

Translation - This drug may kill you but we can't have people with an "MI" label walking around unmedicated. You never know what those crazies might do. If they die, no biggie.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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A plug for electronic medical records wrapped in a press release about a study!

 

Seriously, this issue with antidepressants messing with heart rhythm has been known for years. Ever so often, some paper comes out denying it.

 

Let's face it, antidepressants have an effect on vital signs that's often not a good one.

 

PS I find it incredible that this study found Paxil was not associated with QT prolongation. It's notorious for it. This study is by no means conclusive.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Here's another version of the same report: http://www.medpagetoday.com/Cardiology/Arrhythmias/37082

Increasing doses of citalopram, escitalopram, and amitriptyline were associated with prolongation of corrected QT interval -- and increasing doses of bupropion were associated with shortening of correct QT interval -- after adjustment for various clinical and demographic variables identified as potential confounders.

Hinting why the study may only be indicative:

They acknowledged that the study was limited by the lack of randomization of treatment and dose, which rendered the results subject to confounding. In addition, the use of electrocardiograms in patients taking antidepressants is not routine.

The electrocardiograms may have been ordered only for patients showing signs of cardiac problems. The other drugs may cause problems, but not as obviously as citalopram, escitalopram, and amitriptyline.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 2 years later...

I never had palpitations until withdrawal and they started in the first year. 

 

They improved the 2nd year but got worse in years 3 and 4.

 

I experience a thumping, strong sensation, a fast heartbeat and at other times a light, fast fluttering.  When I lie in bed on my left side (usual side to sleep on) I have to turn over because I can feel it even moving and jumping around, very weird.  It is SO HELPFUL to read posts like this and I feel relieved to know it is just another withdrawal symptom.

 

Because I also experience a tight chest and breathlessness the doctor sent me to a specialist and I was diagnosed with Wenkeback level 2.  I gather that means erratic electrical impulse.  When I finish w/d I intend to go back and get tested again and see if it HAS GONE!

 

By the way, I am very impressed with your site and all the research and information that you have gathered.  Thank you SO MUCH for your time and effort.  I hope to get to read it all eventually!

1995-2007      20mg Aropax/Paxil for pain.  Years of up and down doses

2008                Endep, Lexapro and then Esipram (hell!) CT (oh dear!)

2009                20mg Aropax.  Tried skipping doses for a year (more hell!)

                        2010                10mg.  10% taper.  Lasted 4 months. Crashed again

2011                5% taper. 9mg-7mg (hell got even worse!)

2012                2.5% taper.  6.6mg – 5.6mg (worser still & unbearable)

2013                5% taper.  Big mistake.  5.5mg – 4.6mg  (even worserer)

2014                2.5% taper.  4.9mg – 4.5mg;    2015 2.5% taper 4.4 - 4.0mg

2016                2.5% taper.  3.9mg  Feb 3.8   Mar 3.7  May 3.6   Jul 3.5

2017                2.5% taper.  Jan 3.4;   Mar 3.35;  Apr 3.3; Oct 3; Dec 2.9;

2018                2.5% taper. Jan 2.8; Mar 2.7; Mar: 2.75; Jun 2.7; Aug 2.6; Oct 2.5; Nov 2.4; Dec 2.3

2019                Jan 2.2; Feb 2.1;

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  • 7 months later...

Just stumbled onto this thread/topic. I had an episode of atrial fibrillation three weeks ago...the first in my life. Echocardiogram showed normal, structurally healthy heart, and I don't have hypertension, high cholesterol, diabetes, etc., and am otherwise healthy. They sent me home with a blood thinner and a beta blocker; then they switched me to low-dose aspirin, and said I could stop taking the metoprolol if I wanted...that I may or may not have another episode of "paroxysmal" afib.

 

Cardiologist also said that radiation for breast cancer, which I finished in February, could have done cellular damage to my heart, causing electrical/rhythm problems. (Also wondering if the anastrozole I am on -- an aromatase inhibitor that takes estrogen down to almost nothing -- could be contributing.

 

But I am wondering now if withdrawal could be part of the problem. Near the end of my taper off of 20 mg/fluoxetine a day for more than 20 years, I am having high anxiety, palpitations, breathlessness, jumpiness, crying spells, etc. I just don't feel like myself. With all these variables, it's hard to isolate what may be going on.

 

Alto, thanks for your posts from 2013 about palpitations and magnesium. Am going to try magnesium taurate, as you cited.

 

Before looking this up today, I had no idea that AD w/d could contribute to heart rhythm problems. I am so hoping this will go away.

Prozac 20 mg/daily since 1995

July 19, 2013, initial cut to 15 mg; Aug. 2 updosed to 18 mg; Aug. 19, to 16.2 mg
Held at 2.52 ml/day Jan. 11-April 16, 2014
April 16, 2014, cut to 2.40 ml/day
Dec. 29, 2014, 1.84 ml/day, and held there almost six months
June 23, 2015, 1.75ml/day; July 21, 2015, 1.70 ml/day
Aug. 13, 2015, 1.60 ml/day

Feb. 7, 2016, .7 ml/day; April 26, 2016, .6 ml/day

 

Taking anastrozole (estrogen blocker)
 
Successfully completed long, slow Klonopin taper November 2011. :ph34r:

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