Citalopram and escitalopram are selective serotonin reuptake inhibitors (SSRI). These two drugs are no more effective than other SSRI antidepressants, and their adverse effects profile is also very similar. In 2011 and 2012, the Food and Drug Administration (FDA) issued warnings regarding the risks of electrocardiogram QT interval prolongation associated with these two drugs and these warnings were passed on by the medicines agencies, notably the French and British agencies. The warnings were based on pharmacovigilance reports and the findings of placebo-controlled studies. QT interval prolongation exposes patients to a risk of torsades de pointes, a sometimes fatal ventricular arrhythmia disorder.

Several large-scale studies in the USA and in the Netherlands revealed higher QT interval prolongation with citalopram and escitalopram, but not with the other SSRIs.

A Danish case-control study showed a statistically significant link between citalopram and the occurrence of cardiac arrest. An American study carried out on adolescents showed a higher frequency of ventricular arrhythmia and cardiac arrest with citalopram and escitalopram than with other SSRIs. There is also evidence of more severe overdoses with citalopram and escitalopram than with other SSRIs.

Overall, as of early 2016, the available evidence showed that citalopram and escitalopram expose patients to higher cardiac risks than other SSRI antidepressants. Given that they are no more effective, it is better to opt for other SSRIs.

©Prescrire 1 September 2016

"Citalopram, escitalopram and QT prolongation" Prescrire Int 2016; 25 (174): 209-211. (Pdf, subscribers only).