Second generation antidepressants and the risk of arrhythmia

Abstract

Objectives. Second generation antidepressants belong to the most commonly prescribed medications; they are used in the treatment of depression, anxiety disorder, and pain. The aim of the study is to evaluate their risk of QT prolongation, which can lead to potentially life-threatening ventricular arrhythmias. Literature review. Based on the Summary of Product Characteristics and CredibleMeds database, we present current knowledge about the risk of QT prolongation caused by second generation antidepressants. Recommendations concerning planning and conducting treatment using second generation antidepressants are discussed. Conclusions. As scientific research shows, newer antidepressants cause fewer side effects than tricyclic antidepressants, but they are not devoid of them. For some of them, there is a proven risk of QT prolongation and torsade de pointes, which can, very rarely, lead to patient’s death. Before prescribing new antidepressants, clinicians should evaluate the patient’s risk of QT prolongation and, in case of high risk, they should apply the lowest effective dose, regularly monitor the patient’s condition, and inform the patient to consult a cardiologist if any alarming symptoms, such as syncope or palpitations, occur.