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

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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.