Electrocardiographic Changes During Initiation of Lithium Augmentation of Antidepressant Pharmacotherapy
Year: 2021
Type: article
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.
Authors: Maximilian Berger, Josephine Kermer, Joachim Behr, Jeanette Schulz-Menger, Süleyman Bilal, Sarah Luise Osterland, Grace O'Malley, Tom Bschor, Peter Schlattmann, Thomas Stamm, Bruno Steinacher, Walter de Millas, Christoph Richter, Andreas Heinz, Mazda Adli, Pichit Buspavanich, Roland Ricken
Institutions: Medizinische Hochschule Brandenburg Theodor Fontane, Charité – Universitätsmedizin Berlin, Max Delbrück Center, DRK Kliniken Berlin, University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg, Helios Hospital Berlin-Buch, University Hospital Carl Gustav Carus, Technische Universität Dresden, Jena University Hospital, Friedrich Schiller University Jena, Vivantes Klinikum
Language: English
Subfield: Pharmacology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3216778819