Antidepressant/Antipsychotic Combo May Increase Risk Of Sudden Cardiac Death

A new study has found that patients taking <"">antipsychotic and antidepressant drug combinations might increase their risks for sudden cardiac death (SCD). The Finnish study, published in the European Heart Journal, revealed that the combination was linked to even greater SCD risks during a coronary event, said News-Medical.

“We’ve known for some time that mental disorders increase the risk of cardiovascular mortality, but it hasn’t been clearly established if psychiatric disorders, such as depression or schizophrenia, predispose to the occurrence of cardiovascular events or if they increase the patient’s vulnerability to suffer fatal outcomes during the event. For the first time, this study has shown us that it is the increased vulnerability during the event that is the determining factor,” said Heikki Huikuri, the study’s lead investigator at the Institute of Clinical Medicine, University of Oulu (Oulu, Finland), wrote News-Medical. “It points to an urgent need to improve screening for cardiovascular risk factors in psychiatric patients,” added Huikuri.

The study suggests, said Huikuri, that the combination should be avoided and that off label use of psychotropic drugs for pain and sleep disorders should be minimized. The study was part of the larger Finnish Genetic Study of Arrhythmic Events (FinGesture), explained News-Medical, which is a prospective case-control study created to compare genetic and other risks for SCD victims to survivors of acute coronary events.

FinGesture collected data on 2,732 consecutive victims of “out-of-hospital” sudden death from a specific area in Northern Finland from 1998 to 2009. Every case received an autopsy confirmation of SCD during an acute coronary event, said News-Medical. The events were compared to a control group of 1,256 survivor patients treated at the University Hospital of Oulu for acute myocardial infarction. Victims’ most recent medication was derived from medico legal autopsy reports and questionnaires answered by victims’ relatives, said News-Medical.

The study revealed that 9.7% of sudden death patients had taken an antipsychotic versus 2.4% in the control group; 8.6 % of sudden death patients had taken an antidepressant, while 5.5% had in the control group, said News-Medical. The research found that the differences in psychotropic outcomes remained significant even after adjusting for use of cardiovascular drugs including aspirin, beta blockers, and angiotensin converting enzyme (ACE) inhibitors.

According to Huikuri, SCD study victims had taken both tricyclic anti-depressants (TCAs) and antipsychotics more frequently; excess use of selective serotonin reuptake inhibitors (SSRIs) and newer antidepressants was not significant. “This clearly shows us that the mental disorder itself was not the reason for the association, but rather that it was the drugs used to treat these patients that made sudden cardiac death more probable,” said Huikuri, reported News-Medical.

Antipsychotics are approved for serious psychiatric conditions; however, the drugs can be used at physician discretion and are being used for a range of disorders. Some of these other uses have seen recent approval by the U.S. Food and Drug Administration (FDA); many have not.

As we’ve pointed out, some of these medications have been linked to prolongation of the QT interval in the electrocardiogram, which can lead to an abnormal heart rhythm, including Torsade de Pointes, which can be fatal. Patients at particular risk include those with underlying heart conditions and those who are predisposed to low levels of potassium (hypokalemia) and magnesium (hypomagnesemia) in the blood. Prolongation of the QT interval can also lead to malignant polymorphic ventricular arrhythmias and sudden death, added News-Medical.

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