Effects of Antidepressants, but not Psychopathology, on Cardiac Sympathetic Control: A Longitudinal Study
Effects of Antidepressants, but not Psychopathology, on Cardiac Sympathetic Control: A Longitudinal Study
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DOI：
10.1038/npp.2012.107
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发表时间：
2012-10-01
影响因子：
7.6
通讯作者：
de Geus, Eco J. C.
中科院分区：
文献类型：
--
作者：
Licht, Carmilla M. M.;Penninx, Brenda W. J. H.;de Geus, Eco J. C.
交感神经活动的增加被认为是抑郁症或焦虑症患者躯体疾病风险升高的一个因素。然而，目前尚不清楚交感神经活动的增加是否反映了焦虑或抑郁的直接影响或抗抑郁药物的间接影响。本研究的目的是纵向测试是否心脏交感神经控制，测量射血前期（PEP），抑郁/焦虑状态和抗抑郁药的使用增加。横断面和纵向数据来自抑郁和焦虑队列：荷兰抑郁和焦虑研究（NESDA）。2838例NESDA受试者（平均年龄41.7岁，66.7%为女性）的基线数据和2226例受试者的2年随访数据可用于分析。纳入了基线或随访时使用或未使用不同抗抑郁药的抑郁/焦虑障碍受试者。PEP通过1.5 h动态阻抗心动图无创测量。横断面分析比较了精神病理组和抗抑郁组的PEP。纵向分析比较了PEP的2年变化与精神病理学和抗抑郁药使用的变化。横断面分析显示，抗抑郁药初治抑郁/焦虑受试者的PEP与对照组相当，而使用三环类（TCA）或联合肾上腺素能/去甲肾上腺素能抗抑郁药（SNRI）的受试者的PEP与对照组相比显著缩短。相比之下，使用选择性5-羟色胺再摄取抑制剂（SSRIs）的受试者的PEP比对照组更长。纵向结果证实了这些发现：与连续非使用者的PEP 2年变化（+2 ms）相比，开始TCA或SNRI治疗的受试者显示PEP显著缩短（-11 ms，p=0.005和p
Increased sympathetic activity has been hypothesized to have a role in the elevated somatic disease risk in persons with depressive or anxiety disorders. However, it remains unclear whether increased sympathetic activity reflects a direct effect of anxiety or depression or an indirect effect of antidepressant medication. The aim of this study was to test longitudinally whether cardiac sympathetic control, measured by pre-ejection period (PEP), was increased by depression/anxiety status and by antidepressant use. Cross-sectional and longitudinal data were from a depression and anxiety cohort: the Netherlands Study of Depression and Anxiety (NESDA). Baseline data of 2838 NESDA subjects (mean age 41.7 years, 66.7% female) and 2-year follow-up data of 2226 subjects were available for analyses. Included were subjects with and without depressive/anxiety disorders, using or not using different antidepressants at baseline or follow-up. The PEP was measured non-invasively by 1.5 h of ambulatory impedance cardiography. Cross-sectional analyses compared PEP across psychopathology and antidepressant groups. Longitudinal analyses compared 2-year changes in PEP in relation to changes in psychopathology and antidepressant use. Cross-sectional analyses showed that antidepressant-naive depressive/anxious subjects had comparable PEP as controls, whereas subjects using tricyclic (TCA) or combined serotonergic/noradrenergic antidepressants (SNRI) had significantly shorter PEP compared with controls. In contrast, subjects using selective serotonin re-uptake inhibitors (SSRIs) had longer PEP than controls. Longitudinal results confirmed these findings: compared with 2-year change in PEP in continuous non-users (+2 ms), subjects who started TCA or SNRI treatment showed significantly shortened PEP (-11 ms, p=0.005 and p