Antidepressant use and risk of out-of-hospital cardiac arrest: a nationwide case-time-control study

Clin Pharmacol Ther. 2012 Jul;92(1):72-9. doi: 10.1038/clpt.2011.368. Epub 2012 May 16.


Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were identified (2001-2007). Association between treatment with specific antidepressants and OHCA was examined by conditional logistic regression in case-time-control models. We identified 19,110 patients with an OHCA; 2,913 (15.2%) were receiving antidepressant treatment at the time of OHCA, with citalopram being the most frequently used type of antidepressant (50.8%). Tricyclic antidepressants (TCAs; odds ratio (OR) = 1.69, confidence interval (CI): 1.14-2.50) and selective serotonin reuptake inhibitors (SSRIs; OR = 1.21, CI: 1.00-1.47) were both associated with comparable increases in risk of OHCA, whereas no association was found for serotonin-norepinephrine reuptake inhibitors/noradrenergic and specific serotonergic antidepressants (SNRIs/NaSSAs; OR = 1.06, CI: 0.81-1.39). The increased risks were primarily driven by: citalopram (OR = 1.29, CI: 1.02-1.63) and nortriptyline (OR = 5.14, CI: 2.17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antidepressive Agents* / adverse effects
  • Antidepressive Agents* / classification
  • Case-Control Studies
  • Citalopram / administration & dosage
  • Citalopram / adverse effects*
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / etiology*
  • Death, Sudden, Cardiac / prevention & control
  • Denmark
  • Depression / drug therapy
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Nortriptyline / administration & dosage
  • Nortriptyline / adverse effects*
  • Odds Ratio
  • Out-of-Hospital Cardiac Arrest / chemically induced*
  • Out-of-Hospital Cardiac Arrest / epidemiology
  • Risk Assessment
  • Time Factors


  • Antidepressive Agents
  • Citalopram
  • Nortriptyline