Electrocardiographic changes during initiation of lithium augmentation of antidepressant pharmacotherapy

Item Type:	Article
Title:	Electrocardiographic changes during initiation of lithium augmentation of antidepressant pharmacotherapy
Creators Name:	Berger, M. and Kermer, J. and Behr, J. and Schulz-Menger, J. and Bilal, S. and Osterland, S.L. and O'Malley, G. and Bschor, T. and Schlattmann, P. and Stamm, T. and Steinacher, B. and de Millas, W. and Richter, C. and Heinz, A. and Adli, M. and Buspavanich, P. and Ricken, R.
Abstract:	PURPOSE/BACKGROUND: Lithium augmentation of antidepressants represents a common strategy to overcome treatment resistance in patients with major depressive disorder. The use of lithium has been associated with cardiovascular adverse effects such as QTc prolongation and tachyarrhythmia. Although the previous studies investigated monotherapy with lithium, the aim of this study was to investigate electrocardiographic changes in LA. METHODS/PROCEDURES: A 12-lead surface electrocardiogram (ECG) was obtained from 38 patients with major depressive disorder before and during LA. Changes in heart rate, PQ, QRS and QTc interval, QT dispersion, ST segment, and T- and U-wave alterations were analyzed using a linear mixed model. FINDINGS/RESULTS: The ECG readings of 33 patients were evaluated. Lithium augmentation was not significantly associated with changes in heart rate, QTc, PQ, or QRS interval. We found a significant decrease in QT dispersion. These results were independent of sex, age, stable comedication, and comorbidities. During LA, we observed 9 cases of T-wave alterations and 2 cases of new U waves. CONCLUSIONS: Our data provide no evidence for serious ECG abnormalities at therapeutic serum lithium levels in patients treated with LA. In particular, we did not find evidence for QTc time lengthening or tachyarrhythmia, such as torsades des pointes. The recommended intervals for ECG checks should be considered to detect long-term effects of LA.
Keywords:	Depression Treatment, Pharmacodynamics, Treatment-Resistant Depression, Lithium Augmentation, Electrocardiography
Source:	Journal of Clinical Psychopharmacology
ISSN:	0271-0749
Publisher:	Lippincott Williams & Wilkins
Volume:	42
Number:	1
Page Range:	87-91
Date:	January 2022
Official Publication:	https://doi.org/10.1097/JCP.0000000000001496
PubMed:	View item in PubMed

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