Antidepressants and QT prolongation

Talking therapy

by Gemita - 2023-10-06 04:29:57

Rose, your comments: “the unexpected need for a pacemaker. And the sudden cessation of doxepin because of QT prolongation. But without doxepin--my QT is getting worse” sounds concerning but I am not sure how any of us can help if your cardiologist and GP are unable to give an opinion or advice?

I note you will be seeing a therapist.  Are you under the care of a psychiatrist, a doctor who will have a specialist knowledge of antidepressants?  That might help.  In my experience a psychotherapist often prefers to work with a patient who is not on any medication, although I realise that some patients will need antidepressant support at some stage in their lives.

I would return to your GP for help and a referral to a psychiatrist for urgent advice and also speak to your pharmacist.  I don’t feel that anyone here can offer advice on a suitable anti depressant when your GP or Cardiologist is unable to give an opinion.  As you say, we will all react differently to powerful medication and will have different health conditions.  What might suit one member, will clearly not suit another and could even be dangerous.

When you say you are supposed to be pacing at less than 10%, I would say, we pace as much as we need to pace in order to “feel” well.  I also have tachy brady syndrome and pace 100% in the right atrium, although with very little pacing in the right ventricle, but some members may need to be 100% paced in both upper and lower chambers in order to “feel” well and that might also be normal.

I see you are already on a beta blocker which should help with any anxiety.  I have taken melatonin in the past to help get a better night’s sleep. 

I hope therapy is effective.  I had some CBT (cognitive behavioural therapy) during a cancer diagnosis.  Facing my fears and talking about them was the best thing I could have done instead of suppressing them.  I would try some talking therapy too since therapy will help to get to the root of your problems without potentially causing dangerous side effects although I appreciate some of us may need medication initially to help with their symptoms.  I hope you get the help you need Rose

Confusing Account

by Penguin - 2023-10-06 05:21:31

'My primary care physician doesn't know what to prescribe because of my PM.' 'My cardiologist won't recommend an anti-depressant because it's not his area of expertise.'

The experts in drugs for depression are Psychiatry. They are well used to treading the line between cardiac effects and anti-depressant therapy and would be able to advise if your primary care doctor and cardiologist are unwilling to do so. 

'So--here I am reaching out to the members of this club for your collective experience.  I realize everyone is different. And most meds have the opposite intended affect on me'. 

Rose, with respect, if your doctors are shying away from prescribing an antidepressant do you really think it is wise to take advice from an oline forum? 

My best advice to you as a layperson would be to persist with the therapy for depression and to try to deal with it without drugs if your doctors are happier to treat it this way.  There are other non drug methods which may help with sleep, although I appreciate that sleep disturbances due to depression / anxiety may not respond to these in the early stages of therapy. 

Rose, I'm a bit confused here. You didn't mention any QT prolongation in previous posts. Are you now saying that this was the reason behind pulling you off doxepin or is there another reason? Was this also the reason for the PM or was it tachy-brady syndrome and / or heart block or SVT or all four? 

Re: Paxil / Seroxat.  The SSRIs and SNRIs are quite a large class of drugs. They come with different side effect profiles and your doctors will consider which drug is best suited to you, should they decide to prescribe one as an adjunct to therapy. Rather than researching different drugs yourself it may be better to discuss options with your general doctor or psychiatry ideally.  Paxil and it's side effect profile will be known to them. 

Edit: Gemita & I cross posted at the same time. Apologies for duplication. 

meds

by Tracey_E - 2023-10-06 10:50:33

I would speak to your pharmacist for recommendations, side effects and interactions are what they know best. Then run that list by the cardiologist to make sure they're ok with it, then ask your primary to prescribe something. 

I like what Tracey said

by Lavender - 2023-10-06 17:03:29

I'm a firm believer of asking my pharmacist about any meds. She knows a lot. Having said that, in reading online, I saw this from several different resources:  fluoxetine (Prozac, Eli Lilly), paroxetine (Paxil, GlaxoSmithKline) and sertraline (Zoloft, Pfizer) had no effect on QT interval, and further analyses did not significantly alter the results.

When I was having post traumatic stress following placement of my pacemaker, my pcp prescribed medical marijuana. I didn't get the prescription filled and went instead with meditation therapy. 
 

I can understand your cardiologist not prescribing for depression. Their area of expertise is the heart. I would think, though, they would know which meds affect the heart. 

I understand though you're asking if anyone here takes Paxil. 

Clarification

by rosebud120 - 2023-10-07 11:55:10

Hi--

Thanks for the responses. Sorry if my comments were confusing. Can only repeat what I understood my cardiologist to say.

He said "your pacemaker is pacing more than I thought it would". 

QT prolongation is a new symptom/condition that has appeared on my last 2 EKGs.

Yes, I normally rely heavily on the advice/knowledge of my pharmacist. I actually reached out to the pharmacist who is part of my health insurance team and my local pharmacist. Both were reluctant to address the issue of QT prolongation and anti-depressants. 

Antidepressants and QT prolongation

by Julros - 2023-10-08 14:13:45

Hi Rose, 

Its good to hear that you have a trusted pharmacist. I concur that a psychiatrist is best suited to make medication recommendations. Hopefully your therapist can recommnend someone, or your PCP can make a referral. In fact, I'm surprised that they have reached out already on your behalf. 

EMC - Electronic Medications Compendium

by Penguin - 2023-10-09 15:12:19

Hi Rose, 

The electronic medicines compendium (emc) contains up to date information about medicines licensed for use in the UK. The EMC has more than 14,000 documents, all of which have been checked and approved by either the UK or European government agencies which license medicines. These agencies are the UK Medicines and Healthcare Products Regulatory Agency (MHRA) and the European Medicines Agency (EMA).

I took a look at what the EMC has to say about Paxil which is also known as Seroxat and Paroxetine.  I specifically looked at the patient information and the information for health professsionals with regard to Paxil's effect on a) long QT intervals and b) sleep.  This is what it says: 

The Patient Information says: 

i) you should check with your doctor if you have QT prolongation or low heart rate before you take Paxil / Seroxat / Paroxetine  (warnings & precautions section)

ii) common side effects of Paxil / Seroxat / Paroxetine include: sleep disturbances which are described as vivid dreams, nightmares, inability to sleep.  These affect 1 in 10 people who take the drug.

This information is listed here:  https://www.medicines.org.uk/emc/files/pil.7593.pdf

The section for Health Professionals says:

Cases of QT interval prolongation have been reported during the post-marketing period. Paroxetine should be used with caution in patients with a (family) history of QT interval prolongation, concomitant use of antiarrhythmic medications or other medications that may potentially prolong QT interval, relevant pre-existing cardiac disease such as heart failure, ischaemic heart disease, heart block or ventricular arrhythmias, bradycardia, and hypokalaemia or hypomagnesemia (see section 4.3 and 4.5).

This information can be found here:  https://www.medicines.org.uk/emc/product/1161 

I hope that this information helps you make a decision with your doctors.  

My apologies for such a stern sounding post, but I want to ensure that the information posted comes from a reliable source and that it is as clear as possible given the confusion surrounding what has happened to you.

I wish you all the best Rose.