Do SSRIs Raise Arrhythmia and Sudden Death Risk When Added to Antipsychotics?

<jats:p>SSRI initiation in patients already taking an antipsychotic was associated with increased risk of ventricular arrhythmia or sudden death across two large claims-based cohorts. However, events were rare: approximately 0.1% in the US cohort and 0.2% in the Taiwan cohort. In the US, the increased risk was concentrated among patients starting citalopram or escitalopram. Intepret the results cautiously: the association only barely reached significance and did not hold up in a secondary intention-to-treat analysis. Do not to avoid SSRI–antipsychotic combinations when they are clinically indicated, especially in severe illness such as psychotic depression. Instead, use a risk-stratified approach: consider SSRI choice, drug–drug interactions, cumulative QTc burden, correction of modifiable risk factors, and whether baseline and follow-up ECG monitoring is warranted in patients with elevated cardiac risk.</jats:p>