The Association Between Antidepressant Treatment and Heart Rate Deceleration Capacity in Patients With Mood
Hiroaki Okayasu1, Norio Sugawara1, Kumiko Fujii2
1Department of Psychiatry, Dokkyo Medical University, Shimotsuga, Tochigi, Japan.
Insights
Antidepressant use in mood disorder patients correlates with decreased heart rate deceleration capacity (DC), a predictor of cardiac death. This study found lower DC in patients on antidepressants, suggesting DC evaluation may improve sudden cardiac death risk prediction.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Patients with mood disorders using antidepressants face elevated risks of sudden cardiac death.
- QT interval prolongation is a known risk factor, but its association with antidepressants lacks clarity.
- Decreased heart rate deceleration capacity (DC) is emerging as a significant predictor of cardiac mortality.
Purpose of the Study:
- To reevaluate the risk of sudden cardiac death in patients with mood disorders undergoing antidepressant treatment.
- To assess the association between antidepressant use and heart rate deceleration capacity (DC).
Main Methods:
- Investigated the correlation between DC and antidepressant/psychotropic drug doses in 107 patients with major depressive disorder (MDD) or bipolar disorder (BD) using linear regression.
- Compared DC in MDD patients taking antidepressants with age- and sex-matched healthy controls.
Main Results:
- DC showed a negative, dose-dependent correlation with both tricyclic antidepressants (TCAs) and non-tricyclic antidepressants (non-TCAs).
- MDD patients on antidepressants exhibited significantly lower DC (5.32 ms) compared to healthy controls (7.60 ms).
Conclusions:
- Tricyclic antidepressant use significantly impacts DC decline; non-TCAs may also influence DC, especially with polypharmacy.
- Evaluating DC can enhance the predictive accuracy for sudden cardiac death in mood disorder patients using antidepressants.
Purpose:
Patients with mood disorders treated with antidepressants are at high risk of sudden cardiac death, and QT interval prolongation has been as an indicator of sudden cardiac death, however there is no clarity. Recently, a decreased heart rate deceleration capacity (DC) has been regarded as an accurate predictor of cardiac mortality. We attempted to reevaluate the risk of sudden cardiac death associated with antidepressant use assessed via DC.
Patients And Methods:
We investigated the correlation of the DC of 107 patients with major depressive disorder (MDD) and bipolar disorder (BD), diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, with prescribed doses of antidepressants or other psychotropic drugs via linear regression analysis. We then compared the DC of 68 age- and sex-matched healthy controls with that of 68 MDD patients.
Results:
DC was negatively correlated with both tricyclic antidepressant (TCAs) (PRC = -3.62, 95% CI= -5.69--1,55, p<0.001) and non-tricyclic antidepressant (non-TCAs) use (PRC = -0.69, 95% CI= -1.34--0.042, p<0.05) in a dose-dependent manner. Additionally, we found that MDD patients taking antidepressants had significantly lower DC compared to healthy controls (5.32 vs 7.60ms, p<0.001).
Conclusion:
The use of TCAs would influence the decline in DC, and even the use of non-TCAs may influence the decline in DC when multiple medications are used. Evaluating DC may improve the predictive accuracy of sudden cardiac death in patients with mood disorders taking antidepressants.
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