Search for alternative meds

Dear Dr. Roach: I am writing about a concerning development with my 67-year-old husband. After more than a year of taking a 10 mg dose of escitalopram, his internist increased the dose to 20 mg. This vastly improved his depression symptoms over the past year. For many years, he has taken flecainide for atrial fibrillation.

In early December, a nurse from his cardiologist’s office called, concerned about possible interaction between escitalopram and flecainide. I told her that he had taken escitalopram for a long time with no problems. However, during his subsequent office visit, the cardiologist persuaded him to stop taking escitalopram.

It doesn’t seem like a good idea to stop taking the depression medication cold turkey. There was no attempt by the doctor to find possible alternatives. In the past he has resisted treatment for depression because he doesn’t see the problems. Any thoughts? — R.R.

Flecainide is an anti-arrhythmic drug that does have the potential for toxicity and drug interactions. With escitalopram, a commonly used antidepressant, the concern is for a potential for heart toxicity from a type of finding on the electrocardiogram called a long QT. If your husband had a long QT when on the higher dose of escitalopram and flecainide, stopping one of the two medications is prudent. If the QT was not prolonged, I don’t think either medicine needed to be stopped.

I agree with you that suddenly stopping the antidepressant with apparently no communication with his internist was not a good move. Depression is a serious condition, and the worsening of his symptoms should have been prevented. Escitalopram has several “cousins” that do not prolong the QT that could likely have been used.