title: Effects of Escitalopram on Autonomic Function in Posttraumatic Stress Disorder Among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF).
abstract: OBJECTIVE
  Posttraumatic stress disorder is a chronic, debilitating condition that has become a growing concern among combat veterans. Previous research suggests that posttraumatic stress disorder disrupts normal autonomic responding and may increase the risk of cardiovascular disease and mortality. Measures of heart rate variability and QT interval variability have been used extensively to characterize sympathetic and parasympathetic influences on heart rate in a variety of psychiatric populations. The objective of this study was to better understand the effects of pharmacological treatment on autonomic reactivity in posttraumatic stress disorder.
  
  
  METHODS
  A 12-week, Phase IV, prospective, open-label trial of escitalopram in veterans with combat-related posttraumatic stress disorder and comorbid depression.
  
  
  METHODS
  An outpatient mental health clinic at a Veterans Affairs Medical Center.
  
  
  METHODS
  Eleven male veterans of Operations Enduring Freedom and Iraqi Freedom diagnosed with posttraumatic stress disorder and comorbid depression.
  
  
  METHODS
  Autonomic reactivity was measured by examining heart rate variability and QT interval variability. Treatment safety and efficacy were also evaluated pre- and post-treatment.
  
  
  RESULTS
  We observed a reduction in posttraumatic stress disorder and depression symptoms from pre- to post-treatment, and escitalopram was generally well tolerated in our sample. In addition, we observed a decrease in high frequency heart rate variability and an increase in QT variability, indicating a reduction in cardiac vagal function and heightened sympathetic activation.
  
  
  CONCLUSIONS
  These findings suggest that escitalopram treatment in patients with posttraumatic stress disorder and depression can trigger changes in autonomic reactivity that may adversely impact cardiovascular health.
authors.affiliation: Drs. Ramaswamy, Driscoll, and Bhatia are with the Nebraska Western Iowa Veterans Affairs Healthcare System and Creighton University, Omaha, Nebraska; Dr. Selvaraj is with Creighton University, Omaha, Nebraska; Dr. Madabushi is with Baptist Health System, Birmingham, Alabama; and Dr. Yeragani is with Wayne State University School of Medicine, Detroit, Michigan, and the University of Alberta, Edmonton, Canada.
authors.forename: Sriram
authors.initials: S
authors.lastname: Ramaswamy
authors.affiliation: Drs. Ramaswamy, Driscoll, and Bhatia are with the Nebraska Western Iowa Veterans Affairs Healthcare System and Creighton University, Omaha, Nebraska; Dr. Selvaraj is with Creighton University, Omaha, Nebraska; Dr. Madabushi is with Baptist Health System, Birmingham, Alabama; and Dr. Yeragani is with Wayne State University School of Medicine, Detroit, Michigan, and the University of Alberta, Edmonton, Canada.
authors.forename: Vithyalakshmi
authors.initials: V
authors.lastname: Selvaraj
authors.affiliation: Drs. Ramaswamy, Driscoll, and Bhatia are with the Nebraska Western Iowa Veterans Affairs Healthcare System and Creighton University, Omaha, Nebraska; Dr. Selvaraj is with Creighton University, Omaha, Nebraska; Dr. Madabushi is with Baptist Health System, Birmingham, Alabama; and Dr. Yeragani is with Wayne State University School of Medicine, Detroit, Michigan, and the University of Alberta, Edmonton, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Driscoll
authors.affiliation: Drs. Ramaswamy, Driscoll, and Bhatia are with the Nebraska Western Iowa Veterans Affairs Healthcare System and Creighton University, Omaha, Nebraska; Dr. Selvaraj is with Creighton University, Omaha, Nebraska; Dr. Madabushi is with Baptist Health System, Birmingham, Alabama; and Dr. Yeragani is with Wayne State University School of Medicine, Detroit, Michigan, and the University of Alberta, Edmonton, Canada.
authors.forename: Jayakrishna S
authors.initials: JS
authors.lastname: Madabushi
authors.affiliation: Drs. Ramaswamy, Driscoll, and Bhatia are with the Nebraska Western Iowa Veterans Affairs Healthcare System and Creighton University, Omaha, Nebraska; Dr. Selvaraj is with Creighton University, Omaha, Nebraska; Dr. Madabushi is with Baptist Health System, Birmingham, Alabama; and Dr. Yeragani is with Wayne State University School of Medicine, Detroit, Michigan, and the University of Alberta, Edmonton, Canada.
authors.forename: Subhash C
authors.initials: SC
authors.lastname: Bhatia
authors.affiliation: Drs. Ramaswamy, Driscoll, and Bhatia are with the Nebraska Western Iowa Veterans Affairs Healthcare System and Creighton University, Omaha, Nebraska; Dr. Selvaraj is with Creighton University, Omaha, Nebraska; Dr. Madabushi is with Baptist Health System, Birmingham, Alabama; and Dr. Yeragani is with Wayne State University School of Medicine, Detroit, Michigan, and the University of Alberta, Edmonton, Canada.
authors.forename: Vikram
authors.initials: V
authors.lastname: Yeragani
keywords: PTSD; QT variability; depression; heart rate variability; posttraumatic stress disorder; spectral analysis; sympathetic; vagal