Long QT and SADS

[LiziJenks]

Hello (again),

My health anxiety is taking over and I am really struggling at the minute! So it was a brain tumour last week and this week it's Long QT and sudden adult death syndrome.... I AM TERRIFIED! I take 30mg of citalopram and just read citalopram can cause long QT intervals... So that's scaring me because I can't just stop taking them and last night I woke up with horrendous chest pain but my breathing was fine it was as if all the muscles around my heart were tensing and I was shaking, it's happened before and I was taken to hospital where they did an ecg and blood tests and it all came back fine, it was just anxiety! Would that ecg of picked up anything like long QT a year ago? And then now I've just read something about SADS and I'm scared this will happen to me?! How can o stop worrying? I'm sick of it... It's seriously taking over and I'm constantly looking for reassurance! X

[countrygirl]

Long qt is always picked up on straight forward ecg study. This is why there is a campaign for all teenagers to be given an ecg so they can screen for it although I doubt it will happen.
Although theoretically citalopram can cause heart problems, it seems the risk if tiny and mostly when this drug is combined with other drugs or used at high doses so if you are on the usual low dose its not a problem you need to worry about.

[Elen]

I believe the QT problem with cit was noted on a small percentage of people on a high dosage which is why the max dose was reduced from 60mg to 40mg.

I am afraid that this fear is based on as much fact as your brain tumour.

Have you had therapy for your health anxiety?

[MyNameIsTerry]

Although theoretically citalopram can cause heart problems, it seems the risk if tiny and mostly when this drug is combined with other drugs or used at high doses so if you are on the usual low dose its not a problem you need to worry about.

No, I think what you mean is that it can cause an existing heart condition to worsen, Cit has not been proved to cause them from my reading. Long QT was known for a long time in this med before the 2011 revision. If Cit was known to actually cause a condition, this would have to be recorded by the manufacturer.

Cit causes long QT, which is only dangerous in people with that condition already, and what they found was that it increases with the dosage BUT once you go beyond 40mg this greatly increases in risk. They also found that 60mg barely gives any benefit over 40mg anyway and consequently the maximum was revised to 40mg for 20mg for the over 60's (over 65 in the UK).

The risk up to 40mg is acceptable and guess what? SSRI's are even prescribed to patients with heart conditions as long as it's not an issue for them e.g. a heart attack patient who is now out of the danger zone.

ECG Changes
Electrocardiograms from citalopram (N=802) and placebo (N=241) groups were compared with respect to (1) mean change from baseline in various ECG parameters, and (2) the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. The only statistically significant drug-placebo difference observed was a decrease in heart rate for citalopram of 1.7 bpm compared to no change in heart rate for placebo. There were no observed differences in QT or other ECG intervals.


AND

Monitoring:
-Cardiovascular: ECG monitoring (in patients with risk factors for QT interval prolongation)

Remember, you've these tests and nothing has been found so you do not qualify for this monitoring.

AND

Citalopram has not been systematically evaluated in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were generally excluded from clinical studies during the product's premarketing testing. However, the electrocardiograms of 1,116 patients who received citalopram in clinical trials were evaluated and the data indicate that citalopram is not associated with the development of clinically significant ECG abnormalities.


AND

Citalopram and escitalopram should not be used:
•in patients with congenital long QT syndrome or known pre-existing QT interval prolongation
•in combination with other medicines known to prolong the QT interval


In the latter, there are certain meds that already carry long QT complications as countrygirl says but also there are some meds that cause levels of Cit to increase in the body too and so doctors have to take that into account when dosing to ensure you stay before 40mg BUT they have to do this anyway because adding Cit on top of a drug you already use that does this means you can be getting more than the prescribed dose.

[countrygirl]

Wow thats some information! I didn't write that very well about it causing a heart condition, I should have been more specific about just long qt but I was trying to make it very simple in a general way in the hope I had offered some reassurance.

[MyNameIsTerry]

Just wanted to add to it really, countrygirl, so it's taken as a no chance issue, I was thinking about the other member posting who was seeing the small chance issues and so trying to plug any gap just in case.

You always give lots of reassurance on here, we are all very lucky for you being here for us all, and it was a very valid response that did reassure the OP. :hugs:

[countrygirl]

Thank you Terry thats a nice post. I often dilly dally between giving alot of info like you did ( although I didn't know the info you posted:)) and think I might scare more or not and then that can scare as well!

Keep giving the info - I learn loads from you:yesyes: