Research group Drug treatment of psychiatric symptoms is increasing among young people in Sweden, while more young people are seeking treatment for cardiac symptoms. Psychiatric drugs can have side effects on the heart in adults, but there are knowledge gaps regarding cardiac adverse events among young people with psychotropic drug therapy.
In addition to knowledge gaps regarding cardiac adverse events among young people with psychotropic drug therapy, there is also a lack of studies on long-term treatment, treatment with multiple drugs given at the same time, and studies on whether young people with other conditions, such as congenital heart disease, are more susceptible to these side effects.The P-TACO study aims to investigate possible links between psychiatric drug treatment in children, adolescents and young adults and the risk of cardiac side effects, while identifying safe drugs for psychiatric diseases and symptoms.
The P-TACO study is conducted in collaboration with researchers from different clinical and research methodology specialties, as well as an advisory board of young patients and parents.
These studies assessing the association between psychiatric drug treatment and cardiac symptoms are based on data already available in our national registers. We use the drug register, the patient register, the cause of death registers as well as Statistics Sweden. By
linking data between these registers, we can assess single drugs as well as combinations of drugs, follow a treatment over time, study potential adverse events from the heart and this differs for young people of different ages or between boys / men and girls / women. We also have the opportunity to study whether other diseases or conditions influence the risk of cardiac side effects. In these studies, we are comparing to young individuals who are not on psychiatric medication, or have not sought medical care for cardiac symptoms.
We as researchers cannot identify or calculate risks for individual patients, and all studies aim to calculate risks for large groups of young individuals at a population level.
Cardiac risk assessments to pediatric cardiologists are increasing for psychiatric drug treatment. We have shown that almost 1% of children, adolescents and young adults (aged 5-30 years) using medicines for psychiatric conditions experience adverse cardiac events. The risk is highest for teenage girls and those using anti-anxiety medications or multiple psychitaric psychiatric drugs at the same time. We have also seen that the number of cardiac side effects has increased by about 4% per year. Children and adolescents treated with ADHD medication alone have a higher risk of cardiac side effects in our studies, especially those with congenital heart defects. We have also seen that a certain group of individuals repeatedly are seeking care for heart symptoms, which has led us to study this group extra with new studies.
We have seen in small pilot studies that psychiatric drugs can affect the rhythm of the heart, for example by prolonging the QTc interval on the ECG. This prolongation was particularly evident in young girls. However, we do not know whether these changes can cause serious heart problems and this needs further investigation.
We are now moving forward with studies of drug combinations, especially in certain patient groups, such as those with congenital heart defects.
With better knowledge, we hope to be able to advise on tailored drug treatments for psychiatric diseases and symptoms, which also will take into account individuals with specific conditions. Our goal is to find safe drugs for treatment of an important condition.
Research leader: Estelle Naumburg, Associate Professor, Senior Consultant and Specialist in Pediatric and Adolescent Medicine and Pediatric and Adolescent Cardiology, Umeå University
Research team:
PhD students:
