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Major depression, heart rate, and plasma norepinephrine in patients with coronary heart disease
R M Carney1, K E Freedland, R C Veith
1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
Insights
Depression in coronary heart disease patients is linked to altered autonomic nervous system activity, specifically higher resting heart rate and an exaggerated heart rate response to standing. Norepinephrine levels did not differ between groups.
Area of Science:
- Cardiology
- Psychiatry
- Autonomic Neuroscience
Background:
- Psychiatric depression is linked to adverse outcomes in coronary heart disease (CHD) patients.
- The underlying mechanism remains unclear, but altered autonomic nervous system activity is suspected.
- Elevated heart rate (HR) and norepinephrine (NE) in depressed patients may increase cardiac event risk.
Purpose of the Study:
- To investigate autonomic nervous system activity in depressed CHD patients.
- To compare HR, plasma NE, and blood pressure (BP) between depressed and nondepressed CHD patients.
Main Methods:
- Measured HR, plasma NE, and BP in 50 depressed and 39 nondepressed CHD patients.
- Assessments were conducted at rest and during orthostatic challenge (standing).
Main Results:
- Depressed patients had significantly higher resting HR and an exaggerated HR increase after standing.
- No significant differences were found in plasma NE or BP between groups at rest or during orthostatic challenge.
Conclusions:
- Depression in CHD patients is associated with altered autonomic activity, indicated by elevated resting HR and an exaggerated HR response to orthostatic stress.
- The study did not replicate previous findings of differing NE levels between depressed and nondepressed patients.
Background:
Although it is now well established that psychiatric depression is associated with adverse outcomes in patients with coronary heart disease (CHD), the mechanism underlying this association is unclear. Elevated heart rate (HR) and plasma norepinephrine (NE), possibly reflecting altered autonomic nervous system activity, have been documented in medically well depressed psychiatric patients, and this pattern is associated with increased risk for cardiac events in patients with CHD. The purpose of this study was to determine whether autonomic nervous system activity is altered in depressed CHD patients.
Methods:
HR, plasma NE, and blood pressure (BP) were measured in 50 depressed and 39 medically comparable nondepressed CHD patients at rest and during orthostatic challenge.
Results:
Resting HR (p = .005), and the change from resting HR at 2, 5, and 10 min after standing (p = .02, .004, and .02, respectively), were significantly higher in the depressed than in the nondepressed patients. There were no differences between the groups in NE or in BP at rest, or in standing minus resting change scores at any time during orthostatic challenge (p < .05).
Conclusions:
Depression is associated with altered autonomic activity in patients with CHD, as reflected by elevated resting HR and an exaggerated HR response to orthostatic challenge. Previously reported differences in NE levels between depressed and nondepressed patients were not replicated.