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ORIGINAL ARTICLES |
From the Department of Psychiatry and Psychotherapy (M.K., S.B., J.T., K.-J.B.), University Hospital Jena, Jena, Germany; Institute of Psychosocial Medicine and Psychotherapy (M.K.), University Hospital Jena, Jena, Germany; Institute of Physiology I (M.K.B.), University Hospital Jena, Jena, Germany; Department of Medical Engineering and Biotechnology (S.S., A.V.), University of Applied Sciences, Jena, Germany; Department of Psychiatry and Behavioral Neurosciences (V.K.Y.), Wayne State University School of Medicine, Detroit, MI; Department of Psychiatry (V.K.Y.), University of Alberta, Edmonton, AB, Canada; Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine (K.-J.B.), Ruhr-University, Bochum, Germany.
Address correspondence and reprint requests to Karl-Jürgen Bär, Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, 07743 Jena, Germany. E-mail: Karl-Juergen.Baer{at}med.uni-jena.de
Objective: To investigate cardiac autonomic dysfunction in patients with major depressive disorder (MDD). Research in this area has faced several limitations because of the heterogeneity of the disease, the influence of medication, and methodological shortcomings.
Methods: Participants were 75 patients suffering from an acute recurrent episode of MDD and 75 matched controls. All participants were assessed at baseline for linear and nonlinear parameters of heart rate variability, QT variability and baroreflex sensitivity. Participants with MDD were reassessed after 7 to 9 days of treatment with either a selective serotonin reuptake inhibitor (SSRI) or a serotonin and noradrenaline selective reuptake inhibitor (SNRI) antidepressant.
Results: In the initial examination, patients showed an overall shift of autonomic balance toward sympathetic predominance as compared with matched controls, with a decrease in parasympathetic parameters and baroreflex sensitivity, and an increase in sympathetically influenced QT variability. Overall, antidepressant treatment exacerbated this imbalance, with differential effects observed for SSRI and SNRI treatment. In contrast to autonomic dysfunction in other disorders, such as schizophrenia, autonomic dysfunction in MDD appeared to be independent of disease severity.
Conclusions: Patients suffering from MDD show profound autonomic dysfunction, which is exacerbated by SNRI and to a lesser degree by SSRI treatment. This information could prove important when selecting antidepressant medication for patients at risk for cardiac arrhythmias.
Key Words: major depressive disorder • heart rate variability • baroreflex sensitivity • QT interval variability • vagal function • antidepressants
Abbreviations: ANOVA = analysis of variance; BBI = beat-to-beat interval; BMI = body mass index; BRS = baroreflex sensitivity; bslope = bradycardic slope; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; HAMD = Hamilton Depression Rating Scale; Hc = compression entropy; HF = high frequency of the heart rate variability power spectrum; HRV = heart rate variability; LF = low frequency of the heart rate variability power spectrum; LF/HF = ratio between the low and high frequency of the heart rate variability power spectrum; MANOVA = multivariate analysis of variance; MDD = major depressive disorder; QTV = QT variability; QTvi = QT variability index; SNRI = serotonin and noradrenaline selective reuptake inhibitor; PHVAR = probability of high variability sequences; PLVAR = probability of low variability sequences; RMSSD = square root of the mean squared differences of successive normal-to-normal intervals; RR-interval = interval between consecutive R waves in the electrocardiogram; SBP = systolic blood pressure; SPSS = statistical package for the social sciences; SSRI = selective serotonin reuptake inhibitor; tslope = tachycardic slope.
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