This is so incredibly helpful - thank you SO much for doing a video on QTc. Do you have any guidance for combining modafinil and adderall in general and specifically with long QT type 2? I am on modafinil for idiopathic hypersomnia 50-100mg/day. 12.5 atenolol for QT (without BB is 525, with BB ~440). Now have cognition problems post covid and EEG low beta in frontal lobes with excess theta and delta. Would adderall be safe in a low dose with say 50mg modafinil (to still help orexin)? Do you have anything else to recommend to help cognition/brain fog/executive function in this situation? I am hopeful to be off stimulants once I overcome this.
Can't provide specific advice but some general aspects 1. Slow waves present - have autoimmune conditions or other cases of encephalopathy been ruled out - spect/pet and/ or mri done? Post covid medical issues should be ruled out. ( pls see videos we have done on autoimmunity and also covid neuro psych manifestations). Also narcolepsy to be R/o which can co-host with AI conditions 2. Modafinil is less dopaminergic than Armodafinil. So if cognition is being targeted armodafinil can be used which also treats hypersomnia and also is more dopaminergic. For both ofciytse QTc to be monitored and Rx with cardiology input. 3. Depending on response - stimulants can be added but only if required - methylphenidate is less potent than dexamphetamine. We have done videos on that. Ps not medical advice. Wish you well.
I have qt type2 in my genes. Never had any symptoms until I start taking Prozac and 3 months later I collapsed two times within 12 hours and the hooter monitor recorded torsades de pointes. Prozac was the trigger and now my QT is over 500 ms. Do you recommend Zoloft in my case? I’m now in beta blockers and have an implanted ICD but I’m afraid to take any other medication for my mood swings. Prozac helped but obviously I can’t take it any more.
Sorry to hear. While we can provide any individualised advice in this scenario ; in general - Zoloft is also an SSRI like Prozac. There are agents such as agomelatine , Mirtazapine , vortioxetine which have negligible effect on QTc. Also if mood swings are present as opposed to depression - mood stabilisers such as Lamotrigine may be indicated which again have negligible effect on QT. It’s important to discuss this with your doctor. Here is an article with the agents . psychscenehub.com/psychinsights/qtc-interval-psychotropics-prolonged-qtc/ Ps not medical advice.
@3:20 minute mark, that particular study of the Rotterdam study showed the relative risk was 8x higher in the lower age group(55-68 y/o) than those over 68. Authors explained the conflicting results in the article.
Sir ji, My sister is suffering from mdr and it's longer mdr in which we got 400mg of ecg tablets... But today qtc value of her comes to 493 .... What does it means?? Can you plz explain me in simple language... And what to do??
sorry, what is MDR and 400 mg of which tablets - We cant provide advice so please discuss with the primary prescriber and doctor. In general Qtc is the corrected interval from the start of Q wave to end of the t wave in ECG. 493 is longer than the upper limit of Qtc in women, but this needs to be looked at in a clinical context. So the best thing to do is to seek an opinion of the doctor who prescribed medication or cardiologist
Hi Dr, I've made up my mind and want to try Lexapro (well, they will give me the off-brand version escitalopram). I have AVNRT, which is benign, and to be sure I had an ECG done which came out clear. So no prolonged qt-interval. I am still a bit anxious about developing it because I seem to be prone to having low potassium in my blood. I am having my blood checked tomorrow as a final reassurance. Do you recommend another ECG after a while of being on Lexapro to see if the QT-interval is still good, or isn't that necessary? Also, I had an accident almost two years ago in which I shattered my left tibial plateau (knee) which was put together with plates and screws. I want that removed as soon as the lexapro (hopefully) feels stable. I read that SSRI's can intervere with bone growth. Is this something I should be worried about, as with the removal of the hardware I will have eleven holes in my bone. Thanks in advance
It’s difficult and likely inappropriate to answer these questions as they are best answered by the primary prescriber. In general prolonged QTc interval is not a significant issue in treatment unless there are significant risk factors. Wish you well.
@@PsychiatrySimplified Thank you, they don't seem too bothered, but I am bothered as it's my life. I think I will push for another ECG after about 5 or 6 weeks to see if my QT time has prolonged. As for the hardware removal; you're right, I should just contact mu surgeon about that. Thanks for you response :)
@@PsychiatrySimplifiedHello doctor, three years ago I took escilatopam 10 mg (I'm a man), after two months of taking it my QTc was 458 on the EKG, I don't know if it's normal, I continued taking it for three years and I myself stopped taking it this year, now they prescribed it to me again at the same dose, my concern has always been the QTc, I don't know if I should have an EKG before starting since I haven't had an EKG for like three years or if I should have one after starting the treatment, my fear is that my QTc will rise a lot. Thank you.
since i had covid i have fast heart rate 120 at rest i went to two cardiologist and said my heart is fine . now each time i have flu or gaz in my stomack my heart go speed . now i want to take fluconazole to yeast infection but i am afraid of this condition
Your prescriber will be able to advise if this is necessary. There are a number of factors to take into account - family history , other medications , risk factors , clinical Sx etc. here is a detailed article I wrote on QTc. psychscenehub.com/psychinsights/qtc-interval-psychotropics-prolonged-qtc/
Please discuss this with your doctor. The QTc should always be interpreted in context of heart rate. As tachycardia may over estimate it. Females have a higher QTc than males.
Suggestions of supplementation if low levels is present in the consensus guidelines. Literature does show some orevention potential but have come across only in other medical aspects not in psychotropic.related.qtc prolongation. Do you have any experience in relation to that?
Is it OK to take Metronidazole (antibiotic) and Propranolol (beta blocker) at the same time? I've read there is a risk of developing this QTc prolongation when taking these 2 at the same time. I've been under Propranolol for months now, and a few days ago a dentist prescribed me Metronidazole for an infected tooth, but I forgot to mention Propranolol while I was there. Should I try to change the antibiotic?
We can't provide this specific advice on here as it would be irresponsible. Please discuss with the prescriber and with your doctor if you have these concerns. We wish you well.
Thanks for your comment - it is lurasidone followed by Aripiprazole. LEUCHT 2012 Metanalysis. Covered in more detail here psychscenehub.com/psychinsights/qtc-interval-psychotropics-prolonged-qtc/
Thank you for the quick reply. Your teaching rocks! I worked many years as a psych consultant in acute medical and up in cardiology I often used IV Haldol even with pts that had QT intervals of greater than 500 and my second go to for delirium was olanzapine -never saw a fluctuation in the QT interval surprisingly.
@@Idmoment I agree - I work in CL and cardiologists are not too concerned even with 500 msec and above ( mild) - I have used olanzapine as well as in CL settings can provide good relief for agitation etc. Thanks for sharing your experience
This is within the range for normal limits for females. However if it is an increase from baseline by a significant amount with clinical symptoms this must be discussed with the doctor. Ultimately the clinical symptoms need to be correlated with any numbers and the reasons why the ecg was done. Ps not medical advice
@@shardasharma6509 yes it is at the upper end range. Having said that the number should not be looked at in isolation. Most ECG machines use Bazzett’s formula calculation which can overestimate the rate if HR is fast and underestimate if HR is slow. Hence calculation using the Fredericia formula is recommended. Also one must identify if there has been a jump in QTc. And importantly if there are clinical symptoms. In order to take this into account it is recommended that you speak to your doctor / cardiologist to discuss this. Wish u well.
This is so incredibly helpful - thank you SO much for doing a video on QTc. Do you have any guidance for combining modafinil and adderall in general and specifically with long QT type 2? I am on modafinil for idiopathic hypersomnia 50-100mg/day. 12.5 atenolol for QT (without BB is 525, with BB ~440). Now have cognition problems post covid and EEG low beta in frontal lobes with excess theta and delta. Would adderall be safe in a low dose with say 50mg modafinil (to still help orexin)? Do you have anything else to recommend to help cognition/brain fog/executive function in this situation? I am hopeful to be off stimulants once I overcome this.
Can't provide specific advice but some general aspects
1. Slow waves present - have autoimmune conditions or other cases of encephalopathy been ruled out - spect/pet and/ or mri done? Post covid medical issues should be ruled out. ( pls see videos we have done on autoimmunity and also covid neuro psych manifestations). Also narcolepsy to be R/o which can co-host with AI conditions
2. Modafinil is less dopaminergic than Armodafinil. So if cognition is being targeted armodafinil can be used which also treats hypersomnia and also is more dopaminergic. For both ofciytse QTc to be monitored and Rx with cardiology input.
3. Depending on response - stimulants can be added but only if required - methylphenidate is less potent than dexamphetamine. We have done videos on that. Ps not medical advice. Wish you well.
I have qt type2 in my genes. Never had any symptoms until I start taking Prozac and 3 months later I collapsed two times within 12 hours and the hooter monitor recorded torsades de pointes. Prozac was the trigger and now my QT is over 500 ms. Do you recommend Zoloft in my case? I’m now in beta blockers and have an implanted ICD but I’m afraid to take any other medication for my mood swings. Prozac helped but obviously I can’t take it any more.
Sorry to hear. While we can provide any individualised advice in this scenario ; in general - Zoloft is also an SSRI like Prozac. There are agents such as agomelatine , Mirtazapine , vortioxetine which have negligible effect on QTc. Also if mood swings are present as opposed to depression - mood stabilisers such as Lamotrigine may be indicated which again have negligible effect on QT. It’s important to discuss this with your doctor. Here is an article with the agents . psychscenehub.com/psychinsights/qtc-interval-psychotropics-prolonged-qtc/ Ps not medical advice.
Wilson Steven White Jessica Hall Sarah
Can someone who gets palpitations take hydrochloqroquin
@3:20 minute mark, that particular study of the Rotterdam study showed the relative risk was 8x higher in the lower age group(55-68 y/o) than those over 68. Authors explained the conflicting results in the article.
Sir ji, My sister is suffering from mdr and it's longer mdr in which we got 400mg of ecg tablets... But today qtc value of her comes to 493 .... What does it means?? Can you plz explain me in simple language... And what to do??
sorry, what is MDR and 400 mg of which tablets - We cant provide advice so please discuss with the primary prescriber and doctor. In general Qtc is the corrected interval from the start of Q wave to end of the t wave in ECG. 493 is longer than the upper limit of Qtc in women, but this needs to be looked at in a clinical context. So the best thing to do is to seek an opinion of the doctor who prescribed medication or cardiologist
Hi Dr, I've made up my mind and want to try Lexapro (well, they will give me the off-brand version escitalopram). I have AVNRT, which is benign, and to be sure I had an ECG done which came out clear. So no prolonged qt-interval. I am still a bit anxious about developing it because I seem to be prone to having low potassium in my blood. I am having my blood checked tomorrow as a final reassurance. Do you recommend another ECG after a while of being on Lexapro to see if the QT-interval is still good, or isn't that necessary?
Also, I had an accident almost two years ago in which I shattered my left tibial plateau (knee) which was put together with plates and screws. I want that removed as soon as the lexapro (hopefully) feels stable. I read that SSRI's can intervere with bone growth. Is this something I should be worried about, as with the removal of the hardware I will have eleven holes in my bone.
Thanks in advance
It’s difficult and likely inappropriate to answer these questions as they are best answered by the primary prescriber. In general prolonged QTc interval is not a significant issue in treatment unless there are significant risk factors. Wish you well.
@@PsychiatrySimplified Thank you, they don't seem too bothered, but I am bothered as it's my life. I think I will push for another ECG after about 5 or 6 weeks to see if my QT time has prolonged.
As for the hardware removal; you're right, I should just contact mu surgeon about that. Thanks for you response :)
@@PsychiatrySimplifiedHello doctor, three years ago I took escilatopam 10 mg (I'm a man), after two months of taking it my QTc was 458 on the EKG, I don't know if it's normal, I continued taking it for three years and I myself stopped taking it this year, now they prescribed it to me again at the same dose, my concern has always been the QTc, I don't know if I should have an EKG before starting since I haven't had an EKG for like three years or if I should have one after starting the treatment, my fear is that my QTc will rise a lot. Thank you.
Thank you that was really helpful!!
Glad you found it helpful
since i had covid i have fast heart rate 120 at rest i went to two cardiologist and said my heart is fine . now each time i have flu or gaz in my stomack my heart go speed . now i want to take fluconazole to yeast infection but i am afraid of this condition
please discuss this with your cardiologist as its a very specific question.
What does the literature say about atomoxetine? I see that findings are mixed but I am wondering if I should talk to my doctors about that
Your prescriber will be able to advise if this is necessary. There are a number of factors to take into account - family history , other medications , risk factors , clinical Sx etc. here is a detailed article I wrote on QTc. psychscenehub.com/psychinsights/qtc-interval-psychotropics-prolonged-qtc/
Sir i take cipralex 10mg and my qtc is 474 is it normal?
Please discuss this with your doctor. The QTc should always be interpreted in context of heart rate. As tachycardia may over estimate it. Females have a higher QTc than males.
Thanks alot sir
My heart rate was 111 whn thy found prolonged qtc
Any thoughts on supplementing with oral magnesium while on anti-psychotic therapies with high risk to mitigate increase in Qtc?
Suggestions of supplementation if low levels is present in the consensus guidelines. Literature does show some orevention potential but have come across only in other medical aspects not in psychotropic.related.qtc prolongation. Do you have any experience in relation to that?
8:06 minutes Stertraline -= Low Risk of prolonged QTc.
Is it OK to take Metronidazole (antibiotic) and Propranolol (beta blocker) at the same time? I've read there is a risk of developing this QTc prolongation when taking these 2 at the same time. I've been under Propranolol for months now, and a few days ago a dentist prescribed me Metronidazole for an infected tooth, but I forgot to mention Propranolol while I was there. Should I try to change the antibiotic?
We can't provide this specific advice on here as it would be irresponsible. Please discuss with the prescriber and with your doctor if you have these concerns. We wish you well.
Olanzapine has lowest impact on QTc interval
Thanks for your comment - it is lurasidone followed by Aripiprazole. LEUCHT 2012 Metanalysis. Covered in more detail here psychscenehub.com/psychinsights/qtc-interval-psychotropics-prolonged-qtc/
Thank you for the quick reply. Your teaching rocks! I worked many years as a psych consultant in acute medical and up in cardiology I often used IV Haldol even with pts that had QT intervals of greater than 500 and my second go to for delirium was olanzapine -never saw a fluctuation in the QT interval surprisingly.
@@Idmoment I agree - I work in CL and cardiologists are not too concerned even with 500 msec and above ( mild) - I have used olanzapine as well as in CL settings can provide good relief for agitation etc. Thanks for sharing your experience
Sir my mother qtc level is 595 what does that mean
Please discuss this with a cardiologist urgently. YT is not the appropriate forum to discuss this.
sir my QTC range is 452ms is it ok
This is within the range for normal limits for females. However if it is an increase from baseline by a significant amount with clinical symptoms this must be discussed with the doctor. Ultimately the clinical symptoms need to be correlated with any numbers and the reasons why the ecg was done. Ps not medical advice
sir it's Male QTc not female advice sir
in some clinics its range 460 for male. sir 440 to 460 Is borderline for male and high risk when its greater than 500
@@shardasharma6509 yes it is at the upper end range. Having said that the number should not be looked at in isolation. Most ECG machines use Bazzett’s formula calculation which can overestimate the rate if HR is fast and underestimate if HR is slow. Hence calculation using the Fredericia formula is recommended. Also one must identify if there has been a jump in QTc. And importantly if there are clinical symptoms. In order to take this into account it is recommended that you speak to your doctor / cardiologist to discuss this. Wish u well.
sir ecg bese thik h
What can be done to help this. How often does a QTc greater than 450ms have to happen before its considered a prolonged QT syndrome?
There are so many variables to consider.including heart rate. If in any doubt please.do see a doctor who can clarify things for your purposes.