Increased Odds of Ventricular Arrhythmias Associated with Selective Serotonin Reuptake Inhibitor Use among the Pediatric and Young Adult Population: A Case-Control Study

J Pediatr. 2020 Nov:226:173-178.e8. doi: 10.1016/j.jpeds.2020.07.007. Epub 2020 Jul 6.


Objective: To measure the association between selective serotonin reuptake inhibitor (SSRI) use and out-of-hospital ventricular arrhythmia among the pediatric and young adult population.

Study design: Case-control study using US claims data from 2007 to 2018. Cases were subjects with at least 1 event between ages 2 and 24 years. Controls (matched 10:1 on index date, age, sex, and continuous enrollment) had no events during study period. Independent association between current SSRI use (prescription fill with continuous exposure ending on, or after, the index date) and incident out-of-hospital ventricular arrhythmia (hospitalization or emergency room encounter with primary diagnostic code for ventricular arrhythmia) was estimated using multivariable conditional logistic regression. Separate analyses were performed for pediatric (2-17 years of age) vs young adult (18-24 years of age) subjects and between citalopram/escitalopram vs other SSRIs.

Results: During the study period, 237 eligible cases were identified with 2370 matched controls. Cases were more likely to have government insurance and have a mental health, cardiac, or other complex chronic condition. Thirteen cases (5%) and 15 controls (<1%) had current SSRI exposure. After adjustment for mental health and chronic conditions, there was an increased odds of current SSRI use among cases compared with controls (OR 5.11, 95% CI 1.22-21.37). No difference was observed between pediatric and young adult ages, nor between citalopram/escitalopram and other SSRIs.

Conclusions: These findings demonstrate increased odds of out-of-hospital ventricular arrhythmia associated with SSRI use in the pediatric and young adult population, suggesting a need for heightened awareness and ongoing monitoring of this potential adverse effect.

MeSH terms

  • Adolescent
  • Age Factors
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / epidemiology*
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Citalopram / therapeutic use
  • Escitalopram / therapeutic use
  • Female
  • Hospitalization
  • Humans
  • Logistic Models
  • Male
  • Odds Ratio
  • Risk Factors
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Young Adult


  • Serotonin Uptake Inhibitors
  • Citalopram
  • Escitalopram