Antidepressants and heart-rate variability in older adults: a population-based study

Area of Science:

• Cardiology
• Pharmacology
• Epidemiology

Background:

• Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may negatively impact heart rate variability (HRV).
• Reduced HRV is a known risk factor associated with increased mortality.
• Population-based studies are crucial for understanding drug effects on cardiovascular health.

Purpose of the Study:

• To investigate the association between TCAs, SSRIs, and HRV.
• To determine if antidepressant use influences HRV in a large population cohort.
• To analyze changes in HRV related to the initiation or cessation of antidepressant therapy.

Main Methods:

• Prospective cohort study (Rotterdam Study) with up to five ECGs per participant (1991-2012).
• Analysis of two HRV variables: standard deviation of normal-to-normal RR intervals (SDNN) and root mean square of successive RR interval differences (RMSSD) from 10-s ECGs.
• Comparison of HRV during antidepressant use versus non-use, and analysis of HRV changes on consecutive ECGs.

Main Results:

• A total of 23,647 ECGs from 11,729 participants were analyzed.
• SDNN and RMSSD were significantly lower during TCAs and SSRIs use compared to non-use.
• Starting TCAs correlated with decreased HRV, while stopping TCAs correlated with increased HRV; SSRI initiation/cessation showed no significant HRV association.

Conclusions:

• TCAs demonstrate a consistent association with reduced HRV, suggesting a direct drug effect.
• The association between SSRIs and HRV is less clear, with mixed results potentially influenced by confounding factors.
• Further research is needed to elucidate the complex relationship between SSRIs and cardiovascular autonomic function.