A Sociological Study of Awareness of Practitioning Physicians about the Cardiosafety of Antidepressants

Abstract

Prediction and prevention of cardiotoxic adverse reactions in neurological diseases is a pressing issue due to necessity for long-term use of antidepressant drugs. The aim of the study was to examine the quantity of antidepressant prescriptions, observation of adverse events (especially cardiovascular ones) and the caution in prescribing by practicing neurologists compared with physicians of other specialties. Materials and methods: 97 physicians of various specialties participated in the survey. After excluding physicians who did not use antidepressants in their practice, the participants were divided into two groups: neurologists and physicians of other specialties. Differences in responses between the two groups were assessed with the Pearson chi-square test (χ2) and the Kruskal-Wallis test. Results. The analysis of a survey of physicians using antidepressants in their clinical practice revealed the statistically significant differences between neurologists and physicians of other specialties who participated in the study. Neurologists tend to underestimate the cardiotoxicity of antidepressant medications (particularly SSRIs), which can lead to a potentially fatal complication—ventricular tachycardia (Torsade de Pointes). A statistically significant difference in awareness of the diagnostic criteria for long QT syndrome was found in medical practice of neurologists and physicians in other specialties. Conclusion. As a result of the analysis the obtained results, the following ways of improving the dispensary observation of patients on antidepressants were: increasing awareness and alertness of practicing physicians about the long QT syndrome; ECG monitoring before and during taking antidepressants; collection of family history and life history in patients before prescribing antidepressants. Presence of tachycardia, syncope, or anoxic seizures in a patient taking antidepressants can arise suspicion for TdP, a potentially fatal complication of QT syndrome; it requires immediate discontinuation of the drug, replacement with a less cardiotoxic one, 24-hour Holter ECG monitoring, and pharmacogenetic testing.