Heart Rate Variability in Depressed Patients and Differential Effects of Paroxetine and Amitriptyline on Cardiovascular Autonomic Functions

Abstract

Twenty-four unmedicated patients with episodes of major depression (DSM-III-R) and an age- and sex-matched group of 24 normal subjects underwent a heart rate analysis. The battery of cardiovascular reflex tests included the coefficient of variation while resting (CVr) and during deep breathing (CVdr), a spectral analysis of heart rate variability, the Valsalva test, and the posture index. The depressed patients showed no significant abnormalities in any of the tests as compared to the healthy subjects. The 24 patients were randomly allocated for treatment with either amitriptyline or paroxetine. During treatment with 20 mg paroxetine per day, patients showed no changes in cardiovascular autonomic function tests after 14 days. However, treatment with 150 mg amitriptyline per day decreased all heart rate parameters significantly due to anticholinergic side effects, except heart rate, which increased significantly. As autonomic side effects are a potential hazard of antidepressant therapy, the data suggest that paroxetine is an appropriate antidepressant for cases with pre-existing cardiovascular autonomic neuropathy.

Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

“…Duplicates were removed, titles and abstracts scanned, potential articles read and evaluated against inclusion criteria and authors contacted for additional data when necessary. In total, 140 case-control and 30 treatment 76,83,93,110,116,129,138,141,155,175,[187][188][189][190][191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206] studies were eligible for inclusion in the quantitative synthesis (151 case-control and 43 effect sizes for analysis); 10 of the studies were included in both the case-control and treatment analyses. 76,83,93,110,116,129,138,141,155,175 Four subgroups of disorders (mood, anxiety-related, psychotic and substance dependence disorders) and 2 classes of psychotropic medications (antidepressants and antipsychotics) were included.…”

“…Bär et al 189 Davidson et al 190 188 Dawood et al 110 Khaykin et al 191 Koschke et al 116 Lederbogen et al 192 Prasko et al 76 Rechlin 194 Rechlin 194 Rechlin et al 196 Tucker et al 83 Udupa et al 197 Udupa et al 198 Yeragani et al 201 189 Khaykin et al 191 Lederbogen et al 192 McLeod et al 193 Rechlin 194 Rechlin et al 195 Rechlin et al 195 Rechlin et al 196 Tulen et al 129 Udupa et al 198 Yeragani et al 199 Yeragani et al 200 …”

Gender differences in the relationship between depression and cardiac autonomic function among community elderly

“…Exclusion criteria for study subjects included: (1) failure to provide a history of medical illnesses (n ¼ 3), (2) not receiving regular treatment for medical illnesses (n ¼ 17), and (3) subjects with conditions which affect cardiovascular fluctuations: an implanted cardiac pacemaker, frequent occurrence of atrial fibrillation, premature atrial or ventricular contractions, or other forms of arrhythmia (n ¼ 35). Because of the anticholinergic properties of antidepressants, it has been shown that not only treatment with tricyclic antidepressants but also selective serotonin reuptake inhibitors decreases HRV (Rechlin et al, 1994;Lederbogen et al, 2001). Due to the limited number of subjects (n ¼ 2) who took antidepressants during the study period, we excluded these two subjects as well for the sake of inadequate power as a covariate.…”

Depressed inpatients, electrodermal reactivity, and suicide - a study about psychophysiology of suicidal behavior

“…Chloralhydrate or zopiclon were permitted as soporifics; patients with symptoms of delusion also took the so-called atypical neurolepticum zotepin or haloperidol in lower dosages. Recently the influence of anti-depressants was critically discussed by Schnurr (1990), Rechlin et al (1994), Barg and Wolfersdorf (1996), and Barg et al (1996). It seems that with regard to electrodermal reactivity the general skin conductance level can be influenced by neurdeptics and antidepressants with a high proportion of anticholinergic side-effects, but that the rate of habituation is not affected by this.…”