PVC's & anti-depressants

[lasseire]

I'm a 39 yo female;I exercise regularly and have lost 40 lbs, still have another 40 to go. I was diagnosed w/ benign PVC's in Nov. last year.  They came on suddenly one day - ended up in ER, then sent to cardiologist.  Had EKG, Echo & 24 hr. Holter monitor which showed continuous PVC's - the cardiologist said "more than he was comfortable with".  Otherwise, normal healthy heart function.  At the time, I was taking 10 mg. of Meridia (to help w/ weight loss & mood), 50 mg. of Zoloft (for depression) & 2000 mg. of Metformin (for insulin resistance).  He recommended tapering off the Merdia and added 25 mg. of Atenolol.  I then saw the Electrophysiologist who said I could stop taking the Atenolol as the PVC's are really not threatening nor damaging to my heart.  

I stopped taking the Merdia and the Zoloft and after 6 weeks, the PVC's disappeared.  However, the depression returned w/ a vengeance.  The Meridia worked so well on my mood and weight, we (psychiatrist) decided to try again.  Within 3 days the PVCs were back.  So that was a no-go.  After the PVCs stopped, we started Wellbutrin.  Again, within a day the PVCs were back and more frequent.  My cardiologist is away, but another Dr. in the practice seems to think it would be ok to keep taking it, unless I get other cardiac symptoms.  It's hard to tell if I am having other symptoms, the pvcs are so frequent, though.

My questions; 1. Can an antidepressant trigger PVCs?  Is it more from a serotonin-based med or maybe the norepinephrine (both Wellbutrin & Meridia work on that)?  2. and if they do, is it still safe to use them?  3.  If a medication triggers the PVCs then wouldn't that mean by default it's dangerous to my heart? Even with a healthy heart, if an outside trigger is causing an arrythmia, wouldnt' that mean it's dangerous? and 4.  If the antidepressants are triggering the PVCs what in the world do I take to help my depression & anxiety??

Thanks so much for any help/guidance you can provide,
Colleen

[Michael J. McWilliams, M.D.]

1. Can an antidepressant trigger PVCs?  Is it more from a serotonin-based med or maybe the norepinephrine (both Wellbutrin & Meridia work on that)?

ABSOLUTELY.  It could be either.  I have seem both types of medications increase PVCs and decrease in others.  In some it decreases the anxiety of the PVCs and people tolerate them better.  This is anecdotal of course

2. and if they do, is it still safe to use them?

I have not seen any data to suggest that they are not safe in the setting of a structurally normal heart, but I will have to leave up to you and your doctor.  If I had a patient on a medication like Meridia and increased PVCs, I would recommend that they try to avoid that medication, but that is my opinion.

3.  If a medication triggers the PVCs then wouldn't that mean by default it's dangerous to my heart? Even with a healthy heart, if an outside trigger is causing an arrythmia, wouldnt' that mean it's dangerous?

Not necessarily, caffeine, tea, and chocolate can trigger PVCs and they are not considered dangerous.  I could not find an article that specifically addressed Meridia and PVCs.  I doubt it has been looked into yet.

4.  If the antidepressants are triggering the PVCs what in the world do I take to help my depression & anxiety??

That class of anti depressants has a variety of  interactions with various receptors and affecting each receptor with differing potency.  It often comes down to trial and error.  It might be as simple as trying different medications until you find the one with the fewest side effects and the most relative benefit.  

I hope this helps.  Congratulations on the weight loss and keep up the good work.

[lmthames]

I am so proud you asked this question because I am currently going through the same thing.  I am suffering from depression and anxiety that has gotten significantly worse.  I was started on Effexor XR and after about 4 days started having rolls of PVC's to the point that I was getting light headed and dizzy, having chest pains, and generally feeling bad.  After stopping the Effexor, it took almost two weeks for them to get back to their normal come and go.  It was horrible.  But, now I am going back into my depression and am so easily agitated.  I am so scared to start back on some other med. because the side effects of the PVC's just totally freak me out and scare me to death.  I just am not sure now what I am going to do because I know I need to take something but as scared as I am to try I just don't know.  It is such a horrible place to be.  I have been home from work now for almost 3 weeks because my PVC's were so bad and then I hit bottom after stopping the Effexor.  

Just know that you are not alone and this is a horrible struggle.  Please let me know if you find something that works.

[Brnvc]

Please let me know if you find a solution. I had major depression following open heart surgery and my cardiologists all said zoloft wouldn't elevate the HR so I could take it. Since, I've had such terrible PVC's they're almost disable my ICD (pacing) and my HR has dropped to 45 bpm's because my monitor can't pick up the PVC's -- as many as 360 an hour according to my EP.

I'm back living with the depression (and still fighting the PVC's from my last try at Zoloft). I have no idea what to do. Your post made me realize the tie-in. I had noted the problems began when I started the Zoloft... now I know it.

I really don't know what you do...

[djsunyc]

i posted this on another thread but just wanted to share it here...have you discussed taking a magnesium supplement with your doctor?

i started getting skipped heartbeats 2.5 months ago (diagnosed as benign PAC's).  they were infrequent initially then became very frequent.

so i did some internet searching and saw how some were helped by taking a magnesium supplement.  i talked to my cardiologist and he suggested the same thing.

10 days ago, i started taking magnesium as gluconate by a company called windmill.  (you can go to walgreens.com and search for "magnesium as gluconate).  it's 500mg.  i take 1 tablet with lunch and another tablet with dinner.  (btw, i'm a 33 year old male).  within 3 days, they reduced tremendously and since the 3rd day, i haven't felt any of them at all (knock on wood).

the doctor said if it works, i should feel it within 7-10 days, and i have.

so this may be something you can talk to your doctor about and try.  they're cheap ($5 for a bottle of 90 pills).  note: do not take magnesium oxide (easier to find) b/c it absorbs very poorly and acts like a laxative.

hope this helps.

[Brnvc]

It is essential to controling arrythmias. I'd get it off www.iherb.com. Their quality is the best and cheaper than anywhere. But, I say this honestly: I don't believe taking it makes it safe to take anti-depressants. Their reactions are too strong and scary to mess around with. You will have to try yoga, exercise, meditation, prayer -- anything. Maybe if you can find one that doesn't effect your heart but my reaction to zoloft was equally violent and it took 3 days for my heart to return to normal after trying 1/2 a pill. There is no way I will touch it now. St. John's Wort was reported (in a study by MGH) to be more effective for depression than Prozac but it also speeds up the heart. If you try it, take a few drops only. Also, it takes several weeks to take effect. I may try it... or I may just give thanks that my heart has returned to a steady beat and dance for joy!!! That too will get rid of depression :-)

[limoges49]

If stopping Zoloft because of PVCs, does anybody know how long it will take for the PVCs to stop?  I think I'm in this boat - weaning myself off of Zoloft - PVCs, especially with exercise.  Cardiologist let my comments about Zoloft slip in and out of his ears, and recommends taking a Beta Blocker.  Of course, I'm not SURE the PVCs are due to the Zoloft - but I'd like to give my body a decent chance of returning to "normal" before I does it up with another drug - the Beta Blocker.  Does this sound reasonable to anyone else?  Before Zoloft 6 months ago - NO PVCS.  During Zoloft for 5 months - some PVCs beginning about month 3, worsening with month 4 and 5, and slightly better now that I am weaning my Zoloft.  I'm down to no Zoloft now for about the last 3 days.  The PVCs are bad if I start exercising (like running), but otherwise, I'm not getting them during the day just sitting around like I was.  THoughts????  Thanks in advance!  I do plan to try the magnesium - but I've looked at several drugstores and not found it yet.

[Brnvc]

This is very interesting about Zoloft. I get my worse runs when resting and they tend to abate when moving. So the suggestion for the beta blocker makes sense for you. The beta blocker both lowers blood pressure and slows the heart. With PVC's you need to slow the heart because they're dangerous only when fast -- that's when fibrillation can occur. You need a gentler form of exercise right now.

How long will it take? No one knows because once the ventricle sets up its lovely rhythm, it could continue even without the Zoloft. Any cell in the heart can trigger its rhythm and your ventricle has somehow decided it's needed. So I'd try a small amount of a beta-blocker like atenolol (which won't make you depressed like some others) and MAGNESIUM, MAGNESIUM, MAGNESIUM.

Magnsium is essential. Go online at iherb.com or go to a health food store. You can't afford to be picky now. Just get magnesium into your system -- lots and on a regular basis. Only that will calm your heart down. Add the beta blocker too. It will make exercise more sluggish (but safer) so I'd also cut back (as I said before) on the type: walk fast, don't run; yoga and other "not so aerobic" forms. Don't push your heart now.

Man, I hate the way these cardiologists are oblivious to the SSRI's and the heart's electricity. They all are. Just get the magnesium going, and check your other electrolyes too. For your doc, the beta-blocker is the first line of defense so you should probably try it -- but only a small dose. My resting heart is worse for me so the beta blocker increases the PVS (which have to be kept slow) because with the heart going too slow, the ventricle, again, jumps in to help out. Catch 22. Heart's do their best, doctors are clueless, and it's a wicked world!

So add both I'd say. The magnesium always and a little beta blocker to be safe...

[limoges49]

See my March 24 Post above!  For me, I have figured out (retrospectively), that my PVCs were caused by Zoloft, AND/OR the weaning myself OFF of Zoloft!  No Zoloft now for about 10 days.   My PVCs have gone from numerous times throughout the day (even while watching TV) to MAYBE 1 time during a 2 mile brisk walk with my dog.  I continue to feel better.  At this time, I attribute my PVCs to Zoloft, either the taking of Zoloft, or the withdrawl FROM the Zoloft.  Of course, because I'm not sure, I'm also watching caffeine, and have taken some additional magnesium (but not very much to date only 4 tablets total), but I still believe Zoloft was the culprit of my bouts of PVC.  I still have the Beta Blocker RX, and still have not filled it.  At this point. I am feeling very optimistic I've licked the PVCs by getting off the Zoloft.  ALSO, my magnesium says 400 mg as magnesium oxide and magnesium gluconate - so I doubt I'm getting very much magnesium.  Not that I don't want the Mg, but this makes me think more that getting off the Zoloft was my "key".  By the way, Walgreens in Ohio in the Cincinnati area do NOT carry the Windmill brand, I asked the local manager, she said stocking brands decision is a local or regional thing with Walgreens.