Joel Yager, MD reviewing Rector TS et al. Am J Psychiatry 2016 May 10.

Veterans whose citalopram doses were reduced because of new dosing guidelines experienced more all-cause and depression-related hospitalizations but no improvement related to arrhythmias.

Guidance to help clinicians “choose wisely” by comparing benefits and harms of treatments can have mixed results at times. In 2011, the FDA and Department of Veterans Affairs (VA) stipulated that citalopram should not be prescribed in doses >40 mg/day due to risk for QT interval prolongation. Because the adverse cardiac effect seemed rare and the >40-mg/day dose seemed relatively common, investigators used national VA databases to examine records for 35,848 patients with these high citalopram doses; 18,407 patients with average doses of 64 mg/day had doses reduced after the VA communications, and 17,441 patients had nonreduced doses (average, 63 mg/day).

Analyses of the subsequent 1-year course for the two groups were adjusted for 109 demographic and clinical baseline variables and differing prescription time periods. Patients with new doses ≤40 mg/day were at greater risk for all-cause deaths or hospitalizations (hazard ratio, 4.5) and for having a principal depression diagnosis with death from any cause or depression-related hospitalization (HR, 2.2). Regarding principal arrhythmia diagnoses, all-cause deaths or hospitalizations did not decrease.

Citation(s):

Rector TS et al. Outcomes of citalopram dosage risk mitigation in a veteran population. Am J Psychiatry 2016 May 10; [e-pub].

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