How do you approach antidepressant selection in patients with prolonged QTc?
Is there a QTc threshold at which you avoid specific agents? Which antidepressants do you prefer or avoid? Do you routinely involve cardiology? How do you counsel patients about risk?
2 Answers
Mednet MemberInvited Expert
Psychiatry · University of Colorado
Answered on
In 2018, the American Psychiatric Association published a resource document on "QTc Prolongation and Psychotropic Medications," which was later followed up by a 2020 American Journal of Psychiatry publication:
These manuscripts highlighted a few key points when making clinical decisions related to Q...
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Mednet MemberInvited Expert
Psychiatry · Perelman School of Medicine, University of Pennsylvania
Answered on
Based on a large-scale review (Pillinger et al., PMID 41135546), the only antidepressants that tended (not statistically significant) to increase QT interval in the general population of depressed patients were doxepine, nortriptyline, and amitriptyline.
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