Sudden cardiac death secondary to antidepressant and antipsychotic drugs

Abstract

A number of antipsychotic and antidepressant drugs are known to increase the risk of ventricular arrhythmias and sudden cardiac death. Based largely on a concern over QT prolongation and the development of life-threatening arrhythmias, a number of antipsychotic drugs have been temporarily or permanently withdrawn from the market or their use restricted. Some antidepressants and antipsychotics have been linked to QT prolongation and the development of Torsade de pointes arrhythmias, whereas others have been associated with a Brugada syndrome phenotype and the development of polymorphic ventricular arrhythmias. This review examines the mechanisms and predisposing factors underlying the development of cardiac arrhythmias, and sudden cardiac death, associated with antidepressant and antipsychotic drugs in clinical use.

Ionic and Cellular Mechanisms Underlying the Development of Acquired Brugada Syndrome in Patients Treated with Antidepressants

“…1,3 In a study of 98 patients experiencing an overdose of tricyclic antidepressants, Goldgran-Toledano et al 18 reported that overall mortality among all patients was 3%, but among patients who displayed a Brugada phenotype it was 6.7%. Rouleau et al 3 reported 3 cases of psychotropic drug-induced Brugada ECG, occurring during coadministration of amitriptyline and other antipsychotic drugs.…”

“…1 Amitriptyline, a widely used tricyclic antidepressant, has been reported to induce an ST segment elevation in the right precordial leads (V1-V3) of the electrocardiogram (ECG) consistent with the Brugada syndrome (BrS), thus unmasking BrS. 2,3 BrS is an inherited cardiac disorder associated with a high incidence of sudden death due to the development of life-threatening polymorphic VT and VF.…”

Cardiovascular alterations in eating disorders

“…Bradycardia (heart rate (HR) <60 bpm) is one of the most common symptoms seen in patients with AN (FC <40 bpm is a criterion for hospital admission) [21]; it is a consequence of the reduction of the basal metabolism and of the vagal hypertone; also bradycardia is an adaptive phenomenon to protein-energy malnutrition, allowing, through a reduction in cardiac output, to reduce energy expenditure. Therefore a normal or increased CF, in cases of moderate-severe AN, may be indicative of clinical risk [22].…”

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

“…Ventricular dysrhythmias, including ventricular tachycardia (VT), torsade de pointes (TdP) and ventricular fibrillation (VF), have been reported in association with therapeutic use of or overdose by a number of drugs, most commonly antidepressant and antipsychotic agents [1][2][3][4][5]. Published clinical experience regarding ventricular arrhythmias and TdP in drug overdose is derived primarily from single case reports or small case series [6][7][8][9][10].…”