Bozkurt Ali, Barcin Cem, Isintas Mehmet, Ak Mehmet, Erdem Murat, Ozmenler K Nahit
Department of Psychiatry, Gulhane School of Medicine, Ankara, Turkey.
Isr J Psychiatry Relat Sci. 2013;50(1):40-6.
In this study, we aimed to evaluate the effects of electroconvulsive therapy (ECT) on cardiac autonomic functions (CAF) in patients with major depressive disorder (MDD) using heart rate variability (HRV) analysis.
Fourteen men joined the study. Nine ECTs were administered. Holter monitoring was performed before treatment and at the end of the first, third and sixth weeks of the treatment. The Hamilton Depression Rating Scale (HAM-D) was used to assess symptom severity.
Seven patients responded to ECT. There was a change of 2-hour resting HF, pNN50 and RMSSD scores between week 0 and week 6. This change was not significant after week 1 and week 3. HRV values did not differ when we grouped the patients as responders and non-responders to ECT except the 2-hour resting HF value of responders between week 0 and week 6 and the 24-hour HF value of non-responders between week 1 and week 6. All observed changes showed a decrease in parameters. Overall, the LF/HF ratio did not change significantly in either analysis. HRV values did not correlate with HAM-D scores and no relation was found between treatment response and HRV analysis. After Benferroni-adjustment none of the changes were found statistically significant.
The limitations of the study are the small sample size and the absence of healthy controls.
A consistent change in HRV was not observed in response to ECT in patients with MDD. Accepting the HRV as a promising surrogate marker of autonomic activity, ECT does not cause a significant change in nine male treatment resistant MDD patients cardiac autonomic functions.
在本研究中，我们旨在通过心率变异性（HRV）分析评估电休克疗法（ECT）对重度抑郁症（MDD）患者心脏自主神经功能（CAF）的影响。
14名男性参与了该研究。进行了9次ECT治疗。在治疗前以及治疗的第一、第三和第六周结束时进行动态心电图监测。使用汉密尔顿抑郁量表（HAM-D）评估症状严重程度。
7名患者对ECT有反应。在第0周和第6周之间，2小时静息高频心率变异性（HF）、相邻RR间期差值的均方根（RMSSD）和pNN50得分有变化。在第1周和第3周后，这种变化不显著。当我们将患者分为ECT反应者和非反应者时，除了反应者在第0周和第6周之间的2小时静息HF值以及非反应者在第1周和第6周之间的24小时HF值外，HRV值没有差异。所有观察到的变化均显示参数降低。总体而言，在任何一项分析中，低频/高频（LF/HF）比值均未显著变化。HRV值与HAM-D得分无关，且未发现治疗反应与HRV分析之间存在关联。经邦费罗尼校正后，未发现任何变化具有统计学意义。
本研究的局限性在于样本量小且缺乏健康对照。
在MDD患者中，未观察到ECT引起HRV的一致变化。尽管将HRV视为自主神经活动的一个有前景的替代指标，但ECT在9名男性难治性MDD患者中并未引起心脏自主神经功能的显著变化。
