Pharmacotherapeutic Determinants for QTc Interval Prolongation in Japanese Patients with Mood Disorder

H. Okayasu; Y. Ozeki; K. Fujii; Y. Takano; Y. Saeki; H. Hori; M. Horie; T. Higuchi; H. Kunugi; K. Shimoda

doi:10.1055/s-0032-1308969

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2012; 45(07): 279-283
DOI: 10.1055/s-0032-1308969

Original Paper

Pharmacotherapeutic Determinants for QTc Interval Prolongation in Japanese Patients with Mood Disorder

Authors

H. Okayasu

¹ Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
Y. Ozeki

¹ Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan

² Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
K. Fujii

¹ Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
Y. Takano

¹ Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
Y. Saeki

¹ Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
H. Hori

² Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
M. Horie

³ Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan
T. Higuchi

⁴ National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
H. Kunugi

² Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
K. Shimoda

¹ Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan

Abstract

Introduction:

An increased incidence of sudden death has been observed among patients treated with antidepressants. A prolonged QTc interval is a known prognostic factor for fatal arrhythmia, and several studies have shown that the use of antidepressants can cause a prolonged QTc interval. However, few studies, especially in Japan, have compared the effects of multiple drugs on QTc interval or examined dose relationships in a clinical setting.

Methods:

We compared the effects of antidepressants on QT interval, corrected to QTc by Bazett's formula, in 729 Japanese patients who were diagnosed with mood disorder.

Results:

Using stepwise multiple linear regression analysis, we found that the use of tricyclic antidepressants (P<0.01) and concomitant use of antipsychotics (P<0.05), as well as advanced age and being female (known factors for prolonged QTc interval; both P<0.01), significantly prolonged the QTc interval. Analysis of individual antidepressants also revealed that the use of clomipramine (P<0.01) and amitriptyline (P<0.05) significantly prolonged the QTc interval.

Conclusion:

Our results reveal that tricyclic antidepressants, especially clomipramine and amitriptyline, confer a risk of prolonged QTc interval in a dose-dependent manner. The selective serotonin reuptake inhibitors investigated (fluvoxamine, paroxetine, sertraline) were not indicated as risk factors for QTc prolongation.

Key words

antidepressants - QTc interval - sudden death - tricyclic antidepressants - selective serotonine reuptake inhibitors

Full Text

References

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