Use of selective serotonin re-uptake inhibitors and the heart rate corrected QT interval in a real-life setting: the population-based Rotterdam Study

AimsSelective serotonin re-uptake inhibitors (SSRIs), specifically citalopram and escitalopram, are thought to cause QT(c) prolongation, although studies have shown contradictory results. Nevertheless, a maximum citalopram dosage of 20mg in high risk patients (e.g. >60years of age) is recommended. We aimed to investigate the association between use of (individual) SSRIs and QT(c) in a population-based study in older adults. MethodsThis study, which was part of the prospective Rotterdam Study (period 1991-2012), included participants with up to five electrocardiograms (ECGs). We used linear mixed models to compare QT(c)F (QT corrected according to Fridericia) measured during use of individual SSRIs with QT(c)F measured during non-use of any antidepressant. For citalopram, analyses were additionally restricted to a maximum dosage of 20mg in participants aged 60years and older. ResultsWe included 12 589 participants with a total of 26 620 ECGs of which 436 ECGs were made during SSRI use. The mean QT(c)F was similar during use of any drugs from the SSRI class and during non-use. After stratifying to individual SSRIs, ECGs recorded during use of citalopram had the longest QT(c) compared with ECGs recorded during non-use (+12.8ms, 90% CI 7.5, 18.2). This result remained similar in the analysis comprising participants aged 60years and older with a maximum prescribed daily dosage of 20mg citalopram. ConclusionsAlthough no SSRI class effect was observed, use of citalopram was associated with a longer QT(c)F, even after considering the recommended restrictions. Other SSRIs may not give a clinically relevant QT(c)F prolongation.