抑郁症住院治疗期间的心率变异性
Heart rate variability during inpatient treatment of depression.
作者信息
Geiss Lennard, Beck Beate, Stemmler Mark, Hillemacher Thomas, Hösl Katharina M
机构信息
Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany.
Institute of Psychology, University of Erlangen-Nuremberg, Naegelsbachstr. 49c, 91052 Erlangen, Germany.
出版信息
J Mood Anxiety Disord. 2024 Feb 28;6:100059. doi: 10.1016/j.xjmad.2024.100059. eCollection 2024 Jun.
BACKGROUND
Major depressive disorder (MDD) is linked to reduced heart rate variability, an index of cardiovascular autonomic modulation (CAM). However, treatment effects on CAM are poorly known. Our objective was to assess if initiation of inpatient treatment has a beneficial effect on CAM in MDD patients.
METHODS
In 30 MDD inpatients, we recorded RR-intervals (RRI), continuous blood pressure (BPsys, BPdia), skin conductance levels (SCL), respiration frequency (RESP) and current medication within 24 h (T1) and 3 weeks after hospital admission (T2) during resting state and metronomic breathing. The same parameters were recorded once at baseline in 30 controls without mental disorders. We computed indices of sympathetic modulation, parasympathetic modulation and parameters reflecting total CAM. Physiological parameters were compared using MANCOVAS. Symptoms of depression were assessed using Hamilton rating scale for depression (HAM-D) and Beck Depression Inventory (BDI), we used rmANOVAs to compare t1 and t2 questionnaire data.
RESULTS
BDI and HAM-D scores were lower at T2 than T1 (both p < 0.01). RRI was lower in T1 patients than in controls (p = 0.021), while BPdia (p = 0.038) and RESP (p = 0.014) were higher in T1 patients than controls. MDD patients showed lower parameters of parasympathetic modulation and total CAM than controls during resting state (parasympathetic p = 0.003; total CAM p = 0.017) and metronomic breathing (parasympathetic p = 0.040; total CAM p = 0.007). Analysis unveiled lower parameters of parasympathetic modulation in T1 patients compared to T2 patients during baseline (p = 0.046). No differences between T1 and T2 patients during metronomic breathing were found.
CONCLUSION
MDD patients showed lower CAM than controls. Contrary to our assumption, we found a decline of parasympathetic modulation in MDD patients over the observation span despite symptomatic improvement. The decline is presumably due to the initiation of psychopharmacotherapy and changes in premedication.
背景
重度抑郁症（MDD）与心率变异性降低有关，心率变异性是心血管自主神经调节（CAM）的一个指标。然而，治疗对CAM的影响鲜为人知。我们的目的是评估住院治疗的启动对MDD患者的CAM是否有有益影响。
方法
在30例MDD住院患者中，我们记录了静息状态和节律性呼吸时24小时内（T1）以及入院3周后（T2）的RR间期（RRI）、连续血压（收缩压BPsys、舒张压BPdia）、皮肤电导水平（SCL）、呼吸频率（RESP）和当前用药情况。在30名无精神障碍的对照者中，在基线时记录一次相同参数。我们计算了交感神经调节指数、副交感神经调节指数以及反映总CAM的参数。使用多变量协方差分析比较生理参数。使用汉密尔顿抑郁量表（HAM-D）和贝克抑郁量表（BDI）评估抑郁症状，我们使用重复测量方差分析比较T1和T2时的问卷数据。
结果
T2时的BDI和HAM-D评分低于T1（均p<0.01）。T1时患者的RRI低于对照组（p=0.021），而T1时患者的舒张压（p=0.038）和呼吸频率（p=0.014）高于对照组。在静息状态（副交感神经p=0.003；总CAM p=0.017）和节律性呼吸（副交感神经p=0.040；总CAM p=0.007）期间，MDD患者的副交感神经调节参数和总CAM参数低于对照组。分析显示，在基线时，T1患者的副交感神经调节参数低于T2患者（p=0.046）。在节律性呼吸期间，未发现T1和T2患者之间存在差异。
结论
MDD患者的CAM低于对照组。与我们的假设相反，尽管症状有所改善，但我们发现在观察期内MDD患者的副交感神经调节有所下降。这种下降可能是由于启动了精神药物治疗和术前用药的改变。
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