The impact of psychotherapy on hemodynamic predictors of cardiovascular disease in patients with major depression

前瞻性研究表明，抑郁症患者患心血管疾病的风险增加。抑郁症还与许多血液动力学特征有关，这些特征是已知的心血管疾病的危险因素，如心率加快、心率变异性降低和血压改变。这些血流动力学的改变可以部分解释与抑郁症相关的心血管风险增加。本研究的目的是确定用认知行为疗法（CBT）治疗抑郁症是否能有效降低血液动力学心血管危险因素。血流动力学评估包括心率、心率变异性、持续血压、血压变异性、压力感受器敏感性和周围血管阻力将在基线、治疗后、4周随访和6个月随访时进行。此外，将评估昼夜血流动力学变化，如24小时心率变异性和夜间血压下降。100名重度抑郁症患者将被随机分配到CBT治疗组（每周16小时）或候补组，以控制在没有任何干预和重复测量影响的情况下血液动力学参数的潜在变化。为了评估基线时抑郁症患者的血流动力学指标，还将对50名性别和年龄匹配的健康对照进行血流动力学评估。据推测，治疗期间抑郁症状的减轻伴随着血流动力学参数的改善。以往的研究表明，抑郁症患者的躯体症状可能比认知-情感症状与心血管健康的关系更强。因此，我们进一步假设血液动力学参数的改善主要与躯体症状的改变有关。本研究的主要贡献将是首次使用随机对照试验设计对CBT作为最先进的抑郁症治疗方法进行全面的血流动力学评估。

Prospective studies indicate that patients with depression are at increased risk for cardiovascular disease. Depression is also associated with a number of hemodynamic features, which are known risk factors for cardiovascular morbidity such as increased heart rate, reduced heart rate variability and blood pressure alterations. These hemodynamic alterations may explain in part the increased cardiovascular risk associated with depression. The purpose of this study is to determine whether treatment for depression with cognitive behavior therapy (CBT) is effective in reducing hemodynamic cardiovascular risk factors. Hemodynamic assessments including heart rate, heart rate variability, continues blood pressure, blood pressure variability, baroreceptor sensitivity and peripheral vascular resistance will be conducted at baseline, after treatment, 4 weeks follow up and 6-month follow up. In addition, circadian hemodynamic variations such as 24-hour heart rate variability and nocturnal blood pressure dipping will be assessed. One-hundred patients with Major Depression will be randomly assigned to either a CBT treatment condition (16 hour-long, weekly sessions) or a waitlist condition, to control for potential changes in hemodynamic parameters without any intervention and the impact of repeated-measurement. To evaluate hemodynamic measures in patients with depression at baseline, hemodynamic assessment will also take place in 50 sex- and age-matched healthy controls. It is hypothesized that a reduction of depressive symptoms during treatment is accompanied by an improvement of hemodynamic parameters. Previous research indicates that somatic symptoms in depressed patients may be stronger related to cardiovascular health than cognitive-affective symptoms. Thus, we further hypothesize that an improvement of hemodynamic parameters is primary related to changes in somatic symptoms. The main contribution of this study will be the first comprehensive hemodynamic evaluation of CBT as state of the art treatment for depression using a RCT design.