Arrhythmias & electrophysiologyMeta-analysis
QTc changes and early major adverse cardiovascular events associated with antidepressant treatment for major depressive disorder in adults: individual participant data network meta-regression of double blind randomised trials
- Individual participant data network meta-regression and aggregate pairwise meta-analysis of double-blind randomised trials
Authors' conclusion
The effect of specific antidepressants on QTc interval differed between adults with depression. No evidence associated antidepressant use with early MACE and non-suicidal sudden death.
Study context
- Population
- Adults (≥18 years) with major depressive disorder35 RCTs with individual participant data (IPD)
- Participants
- 8,679 adults
- Comparison
- Specific antidepressants vs placebo
- Outcome
- Change in QTc Fridericia (QTcF) with specific antidepressants and placebo, accounting for modifiable and non-modifiable risk factors
- Follow-up
- First eight weeks of treatment
Pooled result
As reported in the abstract
QTc change vs placebo
Each group vs placeboDifference, ms (95% CrI)
Escitalopram
8.7(1.6–15.8)
Amitriptyline
5.3(0.8–9.8)
- Highest QTc prolongations when risk factors considered: amitriptyline
- 58.8%
- Highest QTc prolongations when risk factors considered: escitalopram
- 21.3%
- Lowest QTc intervals: venlafaxine
- 24.1%
- Lowest QTc intervals: vortioxetine
- 9.7%
Safety
| Outcome | risk difference (95% CrI) | |
|---|---|---|
| Early MACE and non-suicidal death · 139 trials, 52 398 participants; CrI · CrI | 0.01% (−0.01% to 0.02%) | |
| −0.02−0.0100.010.020.03Difference (linear scale) |
Early MACE and non-suicidal death
- No association between antidepressant use and increased early MACE and non-suicidal death
Original publication
QTc changes and early major adverse cardiovascular events associated with antidepressant treatment for major depressive disorder in adults: individual participant data network meta-regression of double blind randomised trials. BMJ. Published 23 September 2026. doi:10.1136/bmj-2026-100600
Summarised from the published abstract; every number is checked against it