Psychiatric drugs don’t affect heart rhythms in hEDS, study finds
hEDS patients more likely than those with HSD to take psychoactive medications
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Medications to treat psychiatric disorders did not affect heart rhythms in people with hypermobile Ehlers-Danlos syndrome (hEDS) in a retrospective study.
Still, “routine cardiovascular monitoring and interdisciplinary care are recommended for hypermobile patients on psychoactive medications,” the researchers wrote.
hEDS patients had a higher psychiatric burden and greater psychoactive medication use than those with hypermobility spectrum disorder (HSD), a similar condition with overlapping features. The study looked at psychiatric and heart data for the two groups.
The study, “Psychoactive medication use and cardiac electrophysiology in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder: a retrospective analysis,” was published in the Journal of Osteopathic Medicine.
EDS is a group of connective tissue disorders characterized by abnormally mobile joints, soft, stretchy skin, and fragile tissues. An HSD diagnosis is applied to individuals who have joint hypermobility alongside significant musculoskeletal complications (pain, instability) but who do not meet the full diagnostic checklist for hEDS.
Psychiatric conditions common
Certain psychiatric conditions, including mood and anxiety disorders, substance abuse disorders, and obsessive-compulsive disorder, are more common in hypermobile patients. These are often treated with psychoactive medications, including antidepressants, antipsychotics, and mood stabilizers, which carry known heart risks, particularly arrhythmias (irregular heartbeats).
Yet “limited research has been conducted in exploring the impact of psychoactive medication use on cardiac electrophysiology in hypermobile patients,” the researchers wrote.
They conducted a retrospective study of 75 adults with hEDS and 34 with HSD who were referred to the Long Island Heart Rhythm Center between 2019 and 2023, comparing psychiatric diagnoses, psychoactive medication use, and electrocardiogram (ECG) findings between the two groups.
According to medical records, the percentage of hEDS patients who had received a psychiatric diagnosis was nearly twice as high as that of HSD patients (72% vs. 38.2%). The biggest differences were seen in trauma- and stressor-related disorders, including post-traumatic stress disorder (PTSD), and in attention-deficit/hyperactivity disorder (ADHD).
hEDS patients also used significantly more psychoactive medications on average (1.8 medications vs. 1.1) and were more likely to use anticonvulsants, medications developed for seizures that are also used for pain and mood (33.3% vs. 8.8%).
“We found that hEDS patients had a higher psychiatric burden and greater psychoactive medication use, suggesting that more complex or severe psychiatric comorbidities [coexisting conditions] requiring pharmacologic intervention,” the team wrote.
Sixty-two participants had 12-lead ECG data available. This included measuring the QTc interval, which reflects the time it takes the heart’s lower chambers to electrically reset between beats. A prolonged QTc, which has been linked to psychoactive medications, can increase the risk of dangerous heart rhythms.
The mean QTc interval was shorter in hEDS patients than in HSD patients (421.62 ms vs. 436.73 ms), though both values fell within the normal range.
Even so, prolonged QTc intervals were found in four times as many HSD patients (26.7% vs 6.4%). As a result, HSD patients were 5.33 times more likely to have a prolonged QTc than those with hEDS.
No significant differences were found between the groups in other ECG measurements. This included heart rate, QRS interval (lower heart contraction), QT interval (lower heart contraction and reset), and PR interval (electrical conduction from the upper to lower heart chambers).
“Interestingly, while hEDS patients exhibited greater psychoactive medication use, it was the HSD cohort that demonstrated a statistically significant QTc difference, although it was still within normal limits,” the researchers noted.
Yet “while psychoactive medication use was greater among hEDS patients, this study was unable to determine the medication effects on ECG findings,” the authors concluded. “The potential for cardiac changes in hypermobile patients warrants routine cardiovascular surveillance and collaborative care between cardiologists and psychiatrists.”
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