Autonomy of autonomic dysfunction in major depression.
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.
Koschke
Mandy
M
Department of Psychiatry and Psychotherapy, University Hospital Jena, 07743 Jena, Germany.
Boettger
Michael K
MK
Schulz
Steffen
S
Berger
Sandy
S
Terhaar
Janneke
J
Voss
Andreas
A
Yeragani
Vikram K
VK
Bär
Karl-Jürgen
KJ
D000208:Acute Disease; D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006321:Heart / Q000294:innervation / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D014179:Neurotransmitter Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000503:physiopathology; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000187:drug effects / Q000503:physiopathology
D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D014179:Neurotransmitter Uptake Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors