QTc interval in patients on psychotropic medications

Prolonged QTc intervals, psychiatric medications, and associated risks such as sudden cardiac deaths and their cardiovascular safety profile are still being studied globally, given the revolution brought by them in the field of psychiatry.

To study the cardiac safety profile of psychotropics in terms of QTc prolongation and establish the safety of psychotropics as a group.

In this study, 121 subjects receiving psychotropic medications were included. ECG of all the patients was performed and followed up to 4 weeks.

The control group showed no difference at any of the three-time intervals, with the mean QTc interval at baseline being 391.3 + 49.70, at one week being 391.3 + 49.70 and at four weeks being 391.3 + 49.70. In contrast, the mean QTc interval for the patients' group was 352.9 + 64.68 at baseline, 353.3 + 649.70 at one week, and 354.4 + 64.82 after four weeks. The difference was found to be substantial (P < 0.001) but negligible (P = 0.078) when the baseline QTc interval was examined for one week. The point that needs to be highlighted here is that significant QTc changes after 4 weeks of starting some psychotropics were noted. However, the number of patients leading to QTc prolongation, i.e. QTc >470 mm/sec in females and >440 mm/sec in males, were, in fact, negligible (3 in number).

Based on the prescribed doses of the medications and any Torsade de pointes (TdP) risk factors, those taking psychiatric medications should have a personalized cardiac monitoring routine. Overall, psychotropics have emerged as a safe option for treating psychiatric illnesses. They do impact the QTc interval, but the number of cases presenting with arrhythmia and other life-threatening cardiac side effects are very few that too if monitored, these risks can be avoided.