A recent study has caused considerable concern regarding the potential association between long-term antidepressant therapy and the risk of sudden cardiac death (SCD) in all ages. This is an overview of the report’s findings, outlines the mechanisms that may be implicated, and offers recommendations for patients and practitioners.
Understanding Sudden Cardiac Death
Sudden cardiac death refers to death attributed to the results of heart trouble. It will be within an hour of beginning if observed or 24 hours from being once alive if unobserved. At less than 39 years of age, a thickening in the heart muscles or electrical irregularity is responsible. On the other hand, narrowed blood vessels giving blood to the heart in older adults are mostly implicated.
The Study: Antidepressants and Sudden Cardiac Death
New research at the European Society of Cardiology’s EHRA 2025 Congress investigated whether the use of antidepressants was associated with a heightened risk of SCD. Scientists compared Danish residents between 18 and 90 years old in 2010 according to death certificates and autopsy reports. Around 643,999 individuals were exposed to antidepressants and a non-exposed control group of 4.3 million residents. In the exposed population, 1,981 individuals died due to SCD versus 4,021 individuals in the non-exposed population.
Possible Mechanisms
The following hypotheses can describe the noted correlation of antidepressant treatment with increased SCD risk:
Cardiac Side Effects: Certain antidepressants, particularly TCAs, exert effects on cardiac rhythm through effects on cardiac ion channels and produce arrhythmias.
QT Interval Prolongation: Some antidepressants have been reported to be associated with QT interval prolongation on an electrocardiogram, making an individual susceptible to Torsades de Pointes, a potentially lethal arrhythmia.
Depression Per Se: Depression in itself is associated with an enhanced risk of cardiovascular complications, including SCD. The emerging increased risk discovered may, in part, represent the severity of the underlying psychiatric illness and not the drug.
Genetic and Individual Susceptibility Factors
Not every patient who is treated with antidepressants develops cardiac side effects, suggesting the patient’s genetic susceptibility. Alterations in the genes that code for the cardiac ion channels, drug-metabolizing enzymes, or the serotonin transporter might potentially change the risk profile of the patient. Pharmacogenetic testing may possibly identify more susceptible subjects to cardiac side effects and thereby allow tailored medicine decisions. The relationship between genetics and secondary cardiac side effects due to antidepressants must be investigated.
Role of Psychiatric Comorbidities in Cardiac Risk
It is important to appreciate the bidirectional association between psychiatric disorders and cardiovascular disease. Anxiety, bipolar disorder, and schizophrenia are also linked with cardiac mortality. Physical findings of chronic stress, such as enhanced levels of cortisol, systemic inflammation, and autonomic dysregulation, can independently increase SCD risk. This calls for an interdisciplinary approach with concomitant psychiatric treatment and cardiovascular risk reduction.
Expert Comments
Dr Jasmin Mujkanovic, a medical doctor and researcher at Rigshospitalet-Copenhagen University and Hospital, Denmark stated, “Time on antidepressants was associated with increased risk of sudden cardiac death and was related to the duration of time on antidepressants.” She asked in the future to separate the medication effects from the comorbid psychiatric illness and lifestyle variables.
But others are warning against interpreting too much into any such findings. They point out that depression as a condition in itself has an increased cardiovascular risk, and that the study could not be controlled for confounding factors like depression severity or other comorbid medical illness.
Even though the findings of the study are disturbing, they do not justify abrupt withdrawal of antidepressant medication with withdrawal syndrome and relapse of depression.
Things Patients should Keep in Mind
Complain to Healthcare Providers: Complain to a healthcare provider before altering drug regimens.
Monitoring Regularly: Participate in regular monitoring of the heart, especially in co-morbidities or risk factors.
Changes in Lifestyle: Implement heart-healthy lifestyles, like exercise, proper nutrition, smoking cessation, and stress reduction.
A Guide to Healthcare Providers
Assess Risk-Benefit Ratio: Weigh the necessity for antidepressant treatment judiciously against both mental health needs and cardiac risk.
Choose Proper Medications: Utilize antidepressants with less risk of cardiac side effects when available, particularly in patients with established cardiac disease.
Monitor Cardiac Health: Include frequent cardiac monitoring in patients taking long-term antidepressants, especially those with additional risk factors.
Implications for Public Health Policy
As antidepressants have become used so extensively, these findings have significant public health relevance. Regulatory bodies and health organizations may be required to revise guidelines to include routine cardiac screening of long-term antidepressant users, particularly those with a history of cardiac disease. Public health communications also must emphasize the utility of lifestyle adjustment in lowering psychiatric as well as cardiovascular risk. Increased funding for research to create safer antidepressant medications and other treatments, such as cognitive-behavioural therapy and neuromodulation procedures, can provide at-risk populations with long-term solutions.
Conclusion
The association between long-term antidepressant therapy and the risk of sudden cardiac death suggests the utility of personalized medicine. Delicate balancing and continued controversy between patients and physicians are necessary to balance the psychological benefits of antidepressants against potential cardiovascular hazards. More research needs to be done before these hazards are well understood and strategies for mitigating them exist.