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，这些特征是心血管疾病的已知危险因素，如心率增加、心率变异性降低和血压变化。这些血流动力学改变可能在一定程度上解释了与抑郁症相关的心血管风险增加。本研究的目的是确定认知行为疗法(CBT)治疗抑郁症在降低血流动力学心血管危险因素方面是否有效。治疗前、治疗结束后、治疗后4周和6个月分别进行心率、心率变异性、持续血压、血压变异性、压力感受器敏感性和外周血管阻力等血流动力学评估。此外，还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名患有严重抑郁症的患者将被随机分配到CBT治疗条件(16小时，每周一次)或等待名单条件下，以控制血流动力学参数的潜在变化，而不需要任何干预和重复测量的影响。为了评估基线时抑郁症患者的血流动力学指标，还将在50名性别和年龄匹配的健康对照组中进行血流动力学评估。假设治疗期间抑郁症状的减少伴随着血流动力学参数的改善。先前的研究表明，抑郁症患者的躯体症状与心血管健康的关系可能比认知-情感症状更强。因此，我们进一步假设血流动力学参数的改善主要与躯体症状的变化有关。这项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.