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Decreased heart rate variability parameters in amitriptyline treated depressed patients: biological and clinical significance

Published online by Cambridge University Press:  16 April 2020

T Rechlin ,
D Claus ,
M Weis  and
WP Kaschka
T Rechlin
Affiliation:
Departments of Psychiatry and Neurology, University of Erlangen-Nürnberg, Psychiatrische Universitätsklinik, Schwabachanlage 6, 91504Erlangen, Germany
D Claus
Affiliation:
Departments of Psychiatry and Neurology, University of Erlangen-Nürnberg, Psychiatrische Universitätsklinik, Schwabachanlage 6, 91504Erlangen, Germany
M Weis
Affiliation:
Departments of Psychiatry and Neurology, University of Erlangen-Nürnberg, Psychiatrische Universitätsklinik, Schwabachanlage 6, 91504Erlangen, Germany
WP Kaschka
Affiliation:
Departments of Psychiatry and Neurology, University of Erlangen-Nürnberg, Psychiatrische Universitätsklinik, Schwabachanlage 6, 91504Erlangen, Germany
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Summary

One hundred-four depressed patients treated with amitriptyline (mean dosage: 163 mg/d; mean plasma level: 239 ng/ml) and 52 normal control subjects matched for age and sex underwent a standardized cardiovascular test battery (various autonomic cardiac parameters, which are largely independent from heart rate, namely the coefficients of variation (CV) while resting and during deep respiration, a spectral analysis of heart rate, the Valsalva ratio, and a posture index were determined). The tests included the determination of time- and frequency-derived measurements of heart rate variability (HRV), which is rather independent from heart rate. As compared to the controls the patients showed a significant plasma concentration-dependent decrease of R-R variation in the electrocardiogram (p < 0.0001), while their heart rate was significantly elevated (p < 0.0001). The markedly reduced parameters of sinus arrhythmia in amitriptyline treated patients are suggested to be mainly due to the anticholinergic effect of this drug, although it can not be excluded that the affective disorder itself might be associated with low heart rate variability. The results indicate that autonomic heart rate parameters are a valuable tool for the detection of tricyclic antidepressant (TCA) intake in unconscious patients, especially in intensive care and emergency wards.

Keywords

heart rate analysisheart rate variabilityamitriptylinecardiovascular autonomic neuropathy
Type
Original article
Information
European Psychiatry , Volume 10 , Issue 4 , 1995 , pp. 189 - 194
Copyright
Copyright © Elsevier, Paris 1995

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References

Akselrod, SGordon, DUbel, FAShannon, DCBarger, ACChen, RJPower spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 1981; 213: 220–2CrossRefGoogle ScholarPubMed
Bannister, RMathias, CTesting autonomic reflexes. In: Bannister, RAutonomic failure: a textbook of clinical disorders of the autonomic nervous system. London: Oxford University Press, 1988; 289–307Google Scholar
Dalack, GWRoose, SPPerspectives on the relationship between cardiovascular disease and affective disorder. J Clin Psychiatry 1990; 51(suppl 7): 4–9Google ScholarPubMed
Ewing, DJCampbell, IWClarke, BFAssessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med 1980; 92: 308–11CrossRefGoogle ScholarPubMed
Freeman, RSaul, JPRoberts, MSBerger, RDBroadbridge, CCohen, RJSpectral analysis in diabetic autonomic neuropathy. Arch Neuro 1991; 48: 185–90CrossRefGoogle ScholarPubMed
Jakobsen, JHauksson, PVestergaard, PHeart rate variation in patients treated with antidepressants. An index of anticholinergic effects?. Psychopharmacology 1984; 84: 544–8CrossRefGoogle ScholarPubMed
Kristensen, EJakobsen, JBartels, UVestergaard, PCholinergic dysfunction of heart, pupil, salivary glands, and urinary bladder in healthy volunteers during long-term treatment with clomipramine. Psychopharmacology 1989; 98: 398–402CrossRefGoogle ScholarPubMed
Langhorst, PSchulz, GLambertz, MOscillating neuronal network of the “common brainstem system”. In: Miyakawa, et al. Mechanism of blood pressure waves 1984; 257–75Google Scholar
Lishner, MAkselrod, SMor Avi, VOz, ODivon, MRavid, MSpectral analysis of heart rate fluctuations. A non-invasive, sensitive method for the early diagnosis of autonomic neuropathy in diabetes mellitus. J Auton Nerv Syst 1987; 19: 119–25CrossRefGoogle ScholarPubMed
Low, PAOpfer-Gehrking, TLDifferential effects of amitriptyline on sudomotor, cardiovagal, and adrenergic function in human subjects. Muscle & Nerve 1992; 15: 1340–4CrossRefGoogle ScholarPubMed
Low, PAAutonomic nervous system function. J Clin Neurophysiol 1993; 10: 14–27CrossRefGoogle ScholarPubMed
O'Brien, IAMcFadden, JPCorrall, RJMThe influence of autonomic neuropathy on mortality in insulin-dependent diabetes. Q J Med New Series 79 1991; 290: 495–502Google Scholar
Pagani, MLombardi, FGuzetti, S et al. Power spectral analysis of heart rate and arterial blood pressure variabilities as a marker of sympathovagal interaction in man and conscious dog. Circ Res 1986; 59: 178–93CrossRefGoogle Scholar
Pomeranz, BMacaulay, RJBCaudill, MAKutz, IAdam, DGordon, DAssessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol 1985; 248: 151–3Google ScholarPubMed
Rechlin, TDecreased parameters of heart rate variation in amiriptyline treated patients: lower parameters in melancholic depression than in neurotic depression: a biological marker? Biol Psychiatry 1994; 36: 705–7CrossRefGoogle ScholarPubMed
Rechlin, TClaus, DWeis, MHeart rate analysis in 24 patients treated with 150 mg amitriptyline per day. Psychopharmacology 1994; 116: 110–14Google ScholarPubMed
Rechlin, TClaus, DWeis, MHeart rate variability in schizophrenic patients and changes of autonomic heart rate parameters during treatment with clozapine. Biol Psychiatry 1994; 35: 888–92CrossRefGoogle ScholarPubMed
Rechlin, TWeis, MClaus, DHeart rate variability in depressed patients and differential effects of paroxetine and amitriptyline on cardiovascular autonomic functions. Pharmacopsychiatry 1994; 21: 124–8CrossRefGoogle Scholar
Rechlin, TWeis, MClaus, DKaschka, WPIdentifying delirious states and autonomic cardiovascular dysfunction associated with amitriptyline treatment by standardized analysis of heart rate. Psychiatry Res 1995; in pressCrossRefGoogle ScholarPubMed
Riddle, MAGeller, BRyan, NAnother sudden death in a child treated with desimipramine. J Am Acad Child Adolesc Psychiatry 1993; 32: 792–5CrossRefGoogle Scholar
Thorogood, MCowen, PMann, JMurphy, PVessey, MFatal myocardial infarction and use of psychotropic drugs in young women. Lancet 1992; 340: 1067–8CrossRefGoogle ScholarPubMed
Weinberg, CRPfeifer, MAAn improved method for measuring heart rate variability: assessment of cardiac autonomic function. Biometrics 1984; 40: 855–61CrossRefGoogle ScholarPubMed
Weise, FHeydenreich, FRunge, UContributions of sympathetic and vagal mechanisms to the genesis of heart rate fluctuation during orthostatic load: a spectral analysis. J Auton Nerv Sys 1987; 21: 127–34CrossRefGoogle Scholar
Yeragani, VKPohl, RBalon, R et al. Heart rate variability in patients with major depression. Psychiatry Res 1992; 37: 35–46CrossRefGoogle Scholar
Yeragani, VKPohl, RRamesh, C et al. Effect of imipramine treatment on heart rate variability measures. Neuropsychobiology 1992; 26: 27–32CrossRefGoogle ScholarPubMed
Yeragani, VKSrinivasan, KPohl, RBerger, RBalon, RRamesh, CEffects of nortriptyline on heart rate variability in panic disorder patients: a preliminary study using power spectral analysis of heart rate. Neuropsychobiology 1994; 29: 1–7CrossRefGoogle ScholarPubMed
Zahn, TPPickar, DAutonomic effects of clozapine in schizophrenia: comparison with placebo and fluphenazine. Biol Psychiatry 1993; 34: 3–12Google ScholarPubMed
Ziegler, DLaux, GDannehl, K et al. Assessment of cardiovascular autonomic function: agerelated normal ranges and reproducility of spectral analysis, vector analysis and standard tests of heart rate variation and blood pressures responses. Diabetic Med 1992a; 9: 166–175CrossRefGoogle Scholar
Ziegler, DGries, FASpüler, MLessmann, FThe epidemiology of diabetic neuropathy. J Diabetic Complications 1992b; 6: 49–57CrossRefGoogle Scholar
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