Carney R M, Freedland K E, Stein P K, Skala J A, Hoffman P, Jaffe A S
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
Psychosom Med. 2000 Sep-Oct;62(5):639-47. doi: 10.1097/00006842-200009000-00007.
Major depression is a common problem in patients with coronary heart disease (CHD) and is associated with an increased risk for cardiac morbidity and mortality. It is not known whether treating depression will improve medical prognosis in patients with CHD. Depression is also associated with elevated heart rate and reduced heart rate variability (HRV), which are known risk factors for cardiac morbidity and mortality that may explain the increased risk associated with depression. The purpose of this study was to determine whether treatment for depression with cognitive behavior therapy (CBT) is associated with decreased heart rate or increased HRV.
Thirty depressed patients with stable CHD, classified as either mildly or moderately to severely depressed, received up to 16 sessions of CBT. The 24-hour heart rate and HRV were measured in these patients and in 22 medically comparable nondepressed controls before and after treatment of the depressed patients.
Average heart rate and daytime rMSSD (reflecting mostly parasympathetic activity) improved significantly in the severely depressed patients, but remained unchanged in the mildly depressed and the control patients. However, only rMSSD improved to a level comparable to the control patients. None of the remaining indices of HRV showed improvement.
The results suggest that treating depression with CBT may reduce heart rate and increase short-term HRV. Thus, CBT may have a beneficial effect on a risk factor for mortality in depressed patients with coronary heart disease. A randomized, controlled study is needed to confirm these findings.
重度抑郁症是冠心病（CHD）患者的常见问题，且与心脏疾病发病率和死亡率的增加相关。目前尚不清楚治疗抑郁症是否会改善冠心病患者的医疗预后。抑郁症还与心率升高和心率变异性（HRV）降低有关，而心率升高和HRV降低是已知的心脏疾病发病率和死亡率的危险因素，这可能解释了与抑郁症相关的风险增加。本研究的目的是确定认知行为疗法（CBT）治疗抑郁症是否与心率降低或HRV增加有关。
30名患有稳定型冠心病的抑郁症患者，分为轻度或中度至重度抑郁症患者，接受了多达16次的CBT治疗。在这些患者以及22名医学上可比的非抑郁症对照者治疗前后，测量了他们的24小时心率和HRV。
重度抑郁症患者的平均心率和日间rMSSD（主要反映副交感神经活动）显著改善，但轻度抑郁症患者和对照者的这些指标保持不变。然而，只有rMSSD改善到与对照者相当的水平。HRV的其余指标均未显示出改善。
结果表明，用CBT治疗抑郁症可能会降低心率并增加短期HRV。因此，CBT可能对冠心病抑郁症患者的死亡风险因素有有益影响。需要进行一项随机对照研究来证实这些发现。
