Electrocardiographic changes associated with SSRI use: Insights from a cross-sectional study in Fasa Adults Cohort Study (FACS)

Fateme Keshtkar; Saba Zangeneh; Mojtaba Farjam; Bahareh Fakhraei; Reza Tabrizi; Azizallah Dehghan; Nematollah Jafari

doi:10.1016/j.jelectrocard.2025.153932

Electrocardiographic changes associated with SSRI use: Insights from a cross-sectional study in Fasa Adults Cohort Study (FACS)

J Electrocardiol. 2025 Apr 14:91:153932. doi: 10.1016/j.jelectrocard.2025.153932. Online ahead of print.

Authors

Fateme Keshtkar¹, Saba Zangeneh¹, Mojtaba Farjam¹, Bahareh Fakhraei², Reza Tabrizi³, Azizallah Dehghan¹, Nematollah Jafari⁴

Affiliations

¹ Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
² Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran; Department of psychiatry, Fasa University of Medical Sciences, Fasa, Iran.
³ Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran; Clinical Research Development Unit, Valiasr Hospital, Fasa University of Medical Sciences, Fasa, Iran.
⁴ University of Poitiers, Center for Research on Cognition and Learning CNRS 7295, Clinical Research Unit in Psychiatry of the Center Hospitalier Henri Laborit, 86000 Poitiers, France.

PMID: 40262478
DOI: 10.1016/j.jelectrocard.2025.153932

Abstract

Background: Serotonin reuptake inhibitors (SSRIs), commonly prescribed for psychiatric disorders, have raised concerns about potential cardiovascular effects. Investigating their influence on specific electrocardiogram (ECG) parameters is crucial for a detailed clinical understanding.

Methods: This cross-sectional study, that utilizes data from the Fasa Adult Cohort Study in Iran, examined 133 individuals on SSRIs. We focused on participants without existing heart conditions, collecting drug details and daily doses through an online survey. ECG recordings that were analyzed by Cardiax® 28 provided insights into various parameters. Statistical analyses, including Mann-Whitney U and linear regression, assessed connections between SSRIs and ECG changes. Ethical approval was obtained for study validity.

Results: Among 133 participants, including citalopram (n = 38), fluoxetine (n = 63), and sertraline (n = 32) groups, this study revealed distinctive electrocardiogram (ECG) changes linked to selective serotonin reuptake inhibitor (SSRI) usage. Significant correlations between SSRIs, and various ECG parameters, with the exception of P duration, were discernible. SSRIs suggested negative correlations with HR, PR, QTC, QRS-axis, RdV5, Sd v2, and reductions in STJ V2, STJ V5, STM V2, STM V5, STE V2, and STE V5 (p < 0.01 or p < 0.05). Positive correlations were observed for QRS, QT, P-axis, and P a2 (p < 0.01 or p < 0.05), highlighting the complicated impact of SSRIs on cardiac electrophysiology.

Conclusion: In conclusion, careful monitoring of ECG parameters during SSRIs treatment is essential, especially in patients with pre-existing cardiac conditions. The observed associations highlight the need for personalized medical guidance when prescribing SSRIs. These findings provide valuable insights into the current medical knowledge, highlighting the need for additional research to completely understand the intricate link between SSRIs and cardiovascular health and to ensure the best possible patient safety. The limitations of this study included the possibility of errors in completing the questionnaires and their incompleteness, lake of baseline ECG which resulted in a decreased number of available cases.

Keywords: Antidepressants; Arrhythmia; Cardiovascular; Central nervous system; Electrocardiogram; SSRI.