OBJECTIVE: Some antidepressants have been implicated as risk factors for QT prolongation, which is a predictor of sudden cardiac death. However, the QT interval is considered an imperfect biomarker for proarrhythmic risk. Therefore, we reevaluated the risk of sudden cardiac death due to antidepressants using improved methods, namely, QT dispersion (QTD), T wave peak-to-end interval (Tp-e), and Tp-e/QT ratio. METHODS: We compared the effects of antidepressants on QTc (QT/RR1/3), QTD, Tp-e, and Tp-e/QT ratio in 378 patients with mood disorder. We also compared each index between 165 healthy controls and 215 randomly selected age-matched patients. RESULTS: Age (p < 0.01), sex (p < 0.05), tricyclic antidepressant (TCA) use (p < 0.05), and clomipramine (p < 0.01) and mianserin (p < 0.05) use in particular, significantly associated with a prolonged QTc. We also found that age (p < 0.01), TCA use (p < 0.05), and clomipramine (p < 0.01) and mianserin (p < 0.05) use in particular, significantly prolonged QTD. However, there was no correlation between each variable and Tp-e or Tp-e/QT ratio. Significant differences in QTc and QTD were found between the patients and healthy controls. CONCLUSION From our results, prediction of risk of sudden cardiac death by QTD, Tp-e, or Tp-e/QT ratio was inconsistent. Increased QTD may be more suitable for predicting sudden cardiac death due to antidepressants.

There are few reports on opioid pharmacokinetics and opioid switching in patients with small intestinal stomas. We experienced a case in which a 40-year-old man with an ileostomy experienced shortened analgesia and increased pain after switching from a fast-release to an extended-release formulation of tramadol. It is possible that the time required for passage through the small intestine and the absorption capacity of the extended-release formulation were insufficient for the extended-release formulation to function effectively, and that more detailed medication adjustment is necessary for patients with small intestinal stomas.