Citalopram - long term

[bigpmcd]

I have been taking citalopram for nearly 7 years now. I cope well and live a relatively anxiety free life.
I have just recently found out that citalopram can cause QT interval (abnormal heart activity) this has been giving me extreme anxiety, which I know deep down is irrational but I felt I needed some advice, hence the post. I feel my heart fluttering slightly now but this is probably my mind playing tricks.
I am fairly young and fit enough and have no family history. I assume I would have known by now if I did have issues. I was planning on visiting my doctor but feel I may look like an idiot thinking irrationally.

Thanks for listening

[panic_down_under]

I have just recently found out that citalopram can cause QT interval (abnormal heart activity) this has been giving me extreme anxiety,

Firstly, many meds can prolong QTc interval, almost literally everything from antibiotics to zit treatments. This is usually not an issue unless there is a specific heart issue.

Whether there really is a problem with citalopram has been contested by pharmacologists and cardiologists. Firstly, some recent studies have raised doubts about how accurately modern ECG/EKG machines calculate QTc suggesting some algorithms such as Bazett's formula don't adequately correct for variations in factors such as bpm rates (see: Sano M (https://www.ncbi.nlm.nih.gov/pubmed/25229724), 2014; Barbey JT (https://www.ncbi.nlm.nih.gov/pubmed/25944685), 2015; Vandenberk B (https://www.ncbi.nlm.nih.gov/pubmed/27317349), 2016; Patel PJ (https://www.ncbi.nlm.nih.gov/pubmed/26552754), 2016).

A second issue is that relatively small increases in QTc interval are raising concerns when the danger is in fact very low. The FDA imposed dose restrictions on citalopram (Celexa) even though the data suggest the increase doesn't appear to be clinically significant. To quote from van Haelst IMM (http://www.psychiatrist.com/_layouts/PPP.Psych.Controls/ArticleViewer.ashx?ArticleURL=/JCP/article/Pages/2014/v75n01/v75n0103.aspx), 2013:

In a thorough QT/QTc study of citalopram, a mean change in QTc interval of 8.5 milliseconds was found for 20 mg per day and 18.5 milliseconds for 60 mg per day. On the basis of these findings, the FDA stated that citalopram should no longer be prescribed at doses of greater than 40 mg per day and that the maximum citalopram dose is 20 mg per day in elderly patients.12 (http://www.fda.gov/drugs/drugsafety/ucm297391.htm) However, there is still no consensus whether an increase in QTc of this magnitude (< 20 milliseconds) for a dosage of 60 mg is clinically relevant.4 (http://doi.wiley.com/10.1111/bcp.12040), 28 (http://dx.doi.org/10.1016/j.amjmed.2011.12.002) The guidelines of the Committee for Proprietary Medicinal Products (CMPC) suggest that individual changes of QTc interval length need to be at least between 30 and 60 milliseconds from baseline to raise concern for potential risk of drug-induced arrhythmias.23-PDF (http://www.fda.gov/ohrms/dockets/ac/03/briefing/pubs/cpmp.pdf) Another commonly accepted threshold for a clinically significant drug-induced change in QTc length is even higher, with an increase = 60 milliseconds.28 (http://dx.doi.org/10.1016/j.amjmed.2011.12.002), 30 (http://dx.doi.org/10.1186/1744-859X-4-1).

For what it's worth, I take the most cardio toxic antidepressant made, dosulepin, aka dothiepin, at well above the recommended dose and annual EKGs/ECGs show it is having no affect on my 70yo ticker.

To allay your fears you could ask your GP for an EKG.


I feel my heart fluttering slightly now but this is probably my mind playing tricks.

Palpitations are not usually an indicator that something is amiss. Everyone has them all the time, it's just anxious minds which tend to notice them. The heart requires (https://www.nytimes.com/1989/01/17/science/in-heartbeat-predictability-is-worse-than-chaos.html) some chaos to work efficiently. Fluctuations are not usually a problem, but a heart beating with metronome regularity can be a very bad sign (and before everyone reading this starts checking their pulse, you need an ECG machine to determine this).