Paroxetine Increases Heart Rate Variability in Panic Disorder

Tucker, Phebe; Adamson, Philip B.; Miranda, Rodrigo; Scarborough, Amy; Williams, David O.; J, Groff; McLean, Heather

doi:10.1097/00004714-199710000-00006

Cited by 82 publications

(10 citation statements)

References 19 publications

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“…Concerning psychotropic treatments, two studies have investigated the impact of pharmacological intervention in isolation on HRV in anxiety patients. First, Tucker et al (110) examined the effect of paroxetine (an SSRI) administration on HRV in 17 PD patients. After 4 weeks of 20 mg of paroxetine daily, parasympathetic activity was significantly increased in patients.…”

Section: Discussionmentioning

confidence: 99%

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

et al. 2014

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Background: Anxiety disorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis.Method: Studies comparing resting-state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis.Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterized by lower HRV [high frequency (HF): Hedges’ g = −0.29. 95% CI: −0.41 to −0.17, p < 0.001; time domain: Hedges’ g = −0.45, 95% CI: −0.57 to −0.33, p < 0.001] than controls. Panic disorder (n = 447), post-traumatic stress disorder (n = 192), generalized anxiety disorder (n = 68), and social anxiety disorder (n = 90), but not obsessive–compulsive disorder (n = 40), displayed reductions in HF HRV relative to controls (all ps < 0.001).Conclusion: Anxiety disorders are associated with reduced HRV, findings associated with a small-to-moderate effect size. Findings have important implications for future physical health and well-being of patients, highlighting a need for comprehensive cardiovascular risk reduction.

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Section: Discussionmentioning

confidence: 99%

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

et al. 2014

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“…In depression, in contrast to other antidepressant categories (e.g., tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors; Siepmann et al, 2007 ; Kemp et al, 2010 ; Chang et al, 2012 ), SSRI treatment has been reported not to have a significant impact on resting HRV ( Rechlin, 1994 ; Straneva-Meuse et al, 2004 ; Koschke et al, 2009 ; Kemp et al, 2010 , 2011 , 2014 ; Brunoni et al, 2013 ; Hanson et al, 2013 ), although contradictory results have also been reported ( Licht et al, 2010 ). In patients with panic disorder or post-traumatic stress disorder, SSRI treatment has been mainly associated with positive effects on HRV measures, i.e., reduced sympathetic activity/normalized ANS activity and baroreflex response ( Tucker et al, 1997 ; Cohen et al, 2000 ). SSRI treatment in patients with cardiovascular diseases has been also associated with an improvement of HRV indices independent of the improvement of depressive symptoms, suggesting a clear benefit for the prognosis of the cardiovascular disease ( Gorman and Sloan, 2000 ; Leftheriotis et al, 2010 ; Mazza et al, 2010 ; Pizzi et al, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

“…To date, effects of SSRI treatment on autonomic reactivity have been only sparsely investigated, predominantly in psychiatric patients using various stressor models. Effects of SSRI treatment on autonomic reactivity have been reported in patients with panic disorder and post-traumatic stress disorder, suggesting a positive effect of SSRIs on HRV reactivity to physiological (orthostatic) or psychological challenges, towards normalizing autonomic indices ( Tucker et al, 1997 , 2000 ).…”

Section: Discussionmentioning

confidence: 99%

Blunted autonomic reactivity to pharmacological panic challenge under long-term escitalopram treatment in healthy men

Agorastos

Kellner

Stiedl

et al. 2015

International Journal of Neuropsychopharmacology

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Background:Central serotonergic pathways influence brain areas involved in vagal cardiovascular regulation and, thereby, influence sympathetic efferent activity. Selective serotonin reuptake inhibitors (SSRIs) affect multiple serotonergic pathways, including central autonomic pathways. However, only a few studies have assessed SSRI-mediated effects on autonomic reactivity in healthy individuals using heart rate variability (HRV).Methods:The present study assessed the influence of long-term treatment with escitalopram (ESC) on autonomic reactivity to an intravenous application of 50 µg cholecystokinin tetrapeptide (CCK-4) in 30 healthy young men using a double-blind, placebo (PLA)-controlled, randomized, within-subject cross-over design. Main outcome measures were time- and frequency-domain HRV parameters, assessed at both baseline and immediately after CCK-4 application.Results:Results showed substantial effects for the treatment × CCK-4 challenge interaction with respect to heart rate (p < 0.001; pη2 = 0.499), SDNN (p < 0.001; pη2 = 576), RMSSD (p = 0.015; pη2 = 194), NN50% (p = 0.008; pη2 = 0.224), and LF% (p = 0.014; pη2 = 0.196), and moderate effects with respect HF% (p = 0.099; pη2 = 0.094), with PLA subjects showing a higher increase in HR and SDNN and a higher decrease in RMSSD, NN50, LF and HF than subjects in the ESC condition. Thus, ESC treatment significantly blunted the autonomic reactivity to CCK-4. Secondary analysis indicated no effect of the 5-HTTLPR polymorphism on CCK-4-induced autonomic response.Conclusions:Our results support findings suggesting an effect of SSRI treatment on autonomic regulation and provide evidence that ESC treatment is associated with blunted autonomic reactivity in healthy men.

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“…Paroxetine can improve heart rate variability and induce a decrease in the relative cardiac sympathetic activity occurring in patients with PD 102 – 105 . In addition, SSRIs have some beneficial effects on the cardiovascular system, such as inhibiting platelet aggregation, collagen, and thrombin, exerting anti-inflammatory effects, and improving endothelial function 106 , which may be protective against cardiovascular morbidity in patients with PD.…”

Section: Are Successful Treatments Of Panic Disorder Specifically Actmentioning

confidence: 99%

Is panic disorder a disorder of physical fitness? A heuristic proposal

Perna

Caldirola²

2018

F1000Res

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Currently, panic disorder (PD) is considered a mental disorder based on the assumptions that panic attacks (PAs) are “false alarms” that arise from abnormally sensitive defense systems in the central nervous system and that PD is treated with therapies specifically acting on anxiety or fear mechanisms. This article aims to propose an alternative perspective based on the results of some experimental studies. Our heuristic proposal suggests not only that PD may be a mental disorder but also that patients with PD have real abnormal body functioning, mainly involving cardiorespiratory and balance systems, leading to a decline in global physical fitness. PAs, as well as physical symptoms or discomfort in some environmental situations, may be “real alarms” signaling that the adaptability resources of an organism are insufficient to respond appropriately to some internal or external changes, thus representing the transient conscious awareness of an imbalance in body functioning. The antipanic properties of several modern treatments for PD may include their beneficial effects on body functions. Although anxiety or fear mechanisms are evidently involved in PD, we hypothesize that a reduction of physical fitness is the “primum movens” of PD, while anxiety or fear is induced and sustained by repeated signals of impaired body functioning. We propose considering panic in a broader perspective that offers a central role to the body and to contemplate the possible role of somatic treatments in PD.

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Paroxetine Increases Heart Rate Variability in Panic Disorder

Cited by 82 publications

References 19 publications

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

Blunted autonomic reactivity to pharmacological panic challenge under long-term escitalopram treatment in healthy men

Is panic disorder a disorder of physical fitness? A heuristic proposal

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