Taking a medication after successful ablation that was contraindicated before

I have a history of anxiety and depression for which I took medication in the past. I have not taken any such meds like that for several years now. Since that time I developed Afib, that's why I am on this forum. 7 weeks ago I had an ablation for it and thus far it has been a great success. I've not had any bouts of arrhythmias. .I'm 2/3 of the way through my blanking period. Without going into a bunch of boring details about my mental health I'll just say my psych doc wants to put me on a SNRI or a tricyclic antidepressant for my mood and to help me sleep which I have lots of trouble with due to my more recent mental state. He has been waiting until my cardiologist says its ok to do so since SNRIs and TCAs cannot be taken if you take an anti-arrhythmic like Flecainide for fear of QT elongation. My cardiologist is of the opinion I no longer need the flecainide ( I only took it as a "pill in a pocket" over the course of 4 years) and I have not taken any for some time before the ablation and none since. . Way back when I took doxepin, which is a TCA, I had no bothersome side affects that I recall and I took it for 20 years. My cardiologist was of the opinion I could go ahead and start taking the doxepin. It would not be at a high dose. Maximum dose is 300mg/day. I would likely be on no more than 25-50mg/day. I just wanted to see if others here have dealt with similar circumstances or have any opinions on the matter. Even though I've had no past bad experiences with doxepin, TCAs are known to have a long list of "possible" side affects. I am wondering if the fact I have had Afib, despite the successful ablation, puts me at more risk for problems down the road. My cardiologist made no hint of that. I presume the only way to know for sure is to try it and see what happens.
Thanks
Pokey

You probably do not need the Flec any longer, but in order to stay on the good side of the EP who has remedied your condition, you might want to consult that person first. But if you're good so far in the blanking period, why not begin to wean your heart off Flecainide, if that is the typical procedure to get off it...I dunno, no experience. I always have thought it best to leave the far end of the blanking period free of any controls so that the Holter shows the correct picture for your sake.My outreach nurse post catheterization told me as much, and encouraged me to get off metoprolol asap before the Holter.

You need sleep, and you need to be destressed, and if it takes some help, for God's sake use it! Anxiety raises catecholamines, which many/most of us in AF are sensitive to. Time to whack that mole. My opinion, and it's only that.

AFAIK, there's no problem between SSRI and flecainide, but someone who knows better will surely pipe up soon.

Since you're going to be off the flecainide, I don't see an issue there. But TCAs have an ungodly long list of drugs, foods, and supplements they interact with, some of which dangerously so. I guess if you took it for 20 years then you know better than I, but that's a class of drugs I would never want to take.

Carey & Gloaming. Thanks for the feedback. I’ve not taken any Flecainide since before my ablation and I only took it PRN when I’d have a bout of AFib. I’m aware of the list of side affects from TCAs. Some are worse than others. SSRIs & SNRIs aren’t much better when it comes to their listed side affects. One of the meds my psych doc posed is Trintellix which is a newer atypical SSRI but I’ve learned you shouldn’t take it with a blood thinner and I’m still on Eliquis which poses the question can one stop Eliquis after a successful ablation or do you have to stay on it out of precaution of getting another possible bout(s) of AFib and thus still at risk of stroke?? But I don’t see Trintellix as an option for me anyway as it is ungodly expensive even after insurance. I also need to research if you can take any SSRI with Eliquis, they may all increase bleeding risk. I’ve not found that to be the case with Doxepin. And as I mentioned I’m pretty sure I only would require a modest dose. And as I said I took it for 20 years with no known/felt ill affects. As u know different people react differently to different drugs. My brother takes 100 mg of metoprolol daily. I couldn’t handle 1/2 of a 25mg tablet, it turned me into a walking zombie. All I know is I have one hell of a hard time getting a decent nights sleep due to pain & my anxiety despite exercise, meditation and CBN and 7.5mg mirtazapine. Doxepin is known to help sleep, anxiety and pain. As you likely know pain, anxiety and poor sleep all feed each other. I’m plumb tired of many mornings waking up feeling like I’ve been hit by a truck

Whether or not you can stop the Eliquis depends on your CHADS-Vasc score. If you're a 1 or lower, your EP will probably allow you to stop. If you're a 2 or higher, probably not.

I will have to review the link you sent. I know nothing about a CHAD-vasc score. Without knowing more at this time if my ablation was successful and I have no arrhythmias going forward why does one need a blood thinner? Is it because having had AFib I’m at risk of getting it again at any time which would put me at risk of stroke??

Don't just review the link; answer the questions on that link and find out what your score is. If you have (or had) afib and/or are on anticoagulants, your CHADS-Vasc score is vitally important. It's something you should know.

You may need an anticoagulant going forward even if you no longer have afib because: 1) like you said, it could come back without you realizing it; and 2) people who've had afib are at a higher risk of stroke even if they no longer experience afib episodes. Your CHADS-Vasc score will determine whether it's safe for you to stop. So go back to that link I have you, answer the questions, and find out what your score is. If it's zero, you can definitely stop the anticoagulant. If it's 1, you can probably stop it but it's a judgement call. If it's 2 or higher then you probably shouldn't stop it even if you're completely afib free.

I’m at least a 2, maybe 3 ☹️ I was on a BB for BP but have stopped that. Don’t know if that counts now or not. Being at least a 2 that alone meaning I need to stay on Eliquis dictates that my psych doc cannot put me on a SNRI OR SSRI as all of them are contraindicated when on a blood thinner.