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

Aims Selective 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 20 mg in high risk patients (e.g. >60 years 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. Methods This 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_cF (QT corrected according to Fridericia) measured during use of individual SSRIs with QT_cF measured during non-use of any antidepressant. For citalopram, analyses were additionally restricted to a maximum dosage of 20 mg in participants aged 60 years and older. Results We included 12 589 participants with a total of 26 620 ECGs of which 436 ECGs were made during SSRI use. The mean QT_cF 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 (+12.8 ms, 90% CI 7.5, 18.2). This result remained similar in the analysis comprising participants aged 60 years and older with a maximum prescribed daily dosage of 20 mg citalopram. Conclusions Although no SSRI class effect was observed, use of citalopram was associated with a longer QT_cF, even after considering the recommended restrictions. Other SSRIs may not give a clinically relevant QT_cF prolongation. [ABSTRACT FROM AUTHOR]