Download PDF
Pharmacopsychiatry 2016; 49(05): 191-198
DOI: 10.1055/s-0042-102964
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

The Effects of Antidepressants and Quetiapine on Heart Rate Variability

W.-L. Huang
1   Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
2   Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
3   Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
4   Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
,
S.-C. Liao
2   Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
3   Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
,
T. B. J. Kuo
5   Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
7   Institute of Translational and Interdisciplinary Medicine, National Central University, Taoyuan, Taiwan
,
L.-R. Chang
2   Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
3   Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
,
T.-T. Chen
1   Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
,
I.-M. Chen
2   Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
6   Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
,
C. C. H. Yang
5   Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
› Author Affiliations
Further Information

Publication History

received 22 October 2015
revised 26 January 2016

accepted 04 February 2016

Publication Date:
29 March 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Introduction: The autonomic effects of antidepressants and quetiapine on heart rate variability (HRV) are inconsistent based on past studies. The aim of this study was to explore their influence on the HRV of psychiatric patients without psychotic symptoms.

Methods: A total of 94 patients with depression, anxiety, or somatic symptoms, were recruited into this study. Based on their medication, 4 groups were identified: the no antidepressant group (n=19), the SSRI group (using sertraline or escitalopram, n=53), the other antidepressants group (using venlafaxine or mirtazapine, n=9), and the augmentation group (AG, using an antidepressant+quetiapine, n=13). The HRV of the 4 groups were compared. The correlations between HRV and the medication(s) used were clarified.

Results: Among the 4 groups, the AG had the lowest HRV with its total power (TP), very low frequency power (VLF) and low frequency power (LF) of HRV being significantly different from those of the other groups. Age and using quetiapine were found to be negatively correlated with TP, VLF and LF. With this study group, the autonomic effects of antidepressants were found not to be significant.

Discussion: Among psychiatric patients without psychotic symptoms, quetiapine causes an overt decrease in HRV.

Key words

heart rate variability - autonomic nervous system - antidepressants - quetiapine
 

  • References

  • 1 Servant D, Logier R, Mouster Y et al. Heart rate variability. Applications in psychiatry. L’Encephale 2009; 35: 423-428
    CrossrefPubMedGoogle Scholar
  • 2 Lo Turco G, Grimaldi Di Terresena L. Spectral analysis of Heart Rate Variability in psychiatric patients: autonomic nervous system evaluation in psychotic, anxiety and depressive disorders. Rivista di psichiatria 2012; 47: 139-148
    PubMedGoogle Scholar
  • 3 Yeragani VK. Heart rate and blood pressure variability: implications for psychiatric research. Neuropsychobiology 1995; 32: 182-191
    CrossrefPubMedGoogle Scholar
  • 4 [Anonymous]. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93: 1043-1065
    CrossrefPubMedGoogle Scholar
  • 5 Kuo TB, Lin T, Yang CC et al. Effect of aging on gender differences in neural control of heart rate. Am J Physiol 1999; 277: H2233-H2239
    PubMedGoogle Scholar
  • 6 Huang WL, Chang LR, Kuo TB et al. Impact of antipsychotics and anticholinergics on autonomic modulation in patients with schizophrenia. J Clin Psychopharmacol 2013; 33: 170-177
    CrossrefPubMedGoogle Scholar
  • 7 Udupa K, Thirthalli J, Sathyaprabha TN et al. Differential actions of antidepressant treatments on cardiac autonomic alterations in depression: A prospective comparison. Asian J Psychiatr 2011; 4: 100-106
    CrossrefPubMedGoogle Scholar
  • 8 Licht CM, de Geus EJ, van Dyck R et al. Longitudinal evidence for unfavorable effects of antidepressants on heart rate variability. Biol Psychiatry 2010; 68: 861-868
    CrossrefPubMedGoogle Scholar
  • 9 Kemp AH, Quintana DS, Gray MA et al. Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry 2010; 67: 1067-1074
    CrossrefPubMedGoogle Scholar
  • 10 Zimmermann-Viehoff F, Kuehl LK, Danker-Hopfe H et al. Antidepressants, autonomic function and mortality in patients with coronary heart disease: data from the Heart and Soul Study. Psychol Med 2014; 44: 2975-2984
    CrossrefPubMedGoogle Scholar
  • 11 Dinleyici EC, Kilic Z, Sahin S et al. Heart rate variability in children with tricyclic antidepressant intoxication. Cardiol Res Pract 2013; 2013: 196506
    PubMedGoogle Scholar
  • 12 van Zyl LT, Hasegawa T, Nagata K. Effects of antidepressant treatment on heart rate variability in major depression: a quantitative review. Biopsychosoc Med 2008; 2: 12
    CrossrefPubMedGoogle Scholar
  • 13 Volkers AC, Tulen JH, van den Broek WW et al. Effects of imipramine, fluvoxamine and depressive mood on autonomic cardiac functioning in major depressive disorder. Pharmacopsychiatry 2004; 37: 18-25
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Siepmann M, Krause S, Joraschky P et al. The effects of St John’s wort extract on heart rate variability, cognitive function and quantitative EEG: a comparison with amitriptyline and placebo in healthy men. Br J Clin Pharmacol 2002; 54: 277-282
    CrossrefPubMedGoogle Scholar
  • 15 Evans DL, Staab J, Ward H et al. Depression in the medically ill: management considerations. Depress Anxiety 1996; 4: 199-208
    CrossrefPubMedGoogle Scholar
  • 16 Rechlin T, Claus D, Weis M et al. Decreased heart rate variability parameters in amitriptyline treated depressed patients: biological and clinical significance. Eur Psychiatry 1995; 10: 189-194
    CrossrefPubMedGoogle Scholar
  • 17 Srinivasan K, Ashok MV, Vaz M et al. Effect of imipramine on linear and nonlinear measures of heart rate variability in children. Pediatr Cardiol 2004; 25: 20-25
    CrossrefPubMedGoogle Scholar
  • 18 Yeragani VK, Rao KA, Pohl R et al. Heart rate and QT variability in children with anxiety disorders: a preliminary report. Depress Anxiety 2001; 13: 72-77
    CrossrefPubMedGoogle Scholar
  • 19 Tulen JH, Bruijn JA, de Man KJ et al. Cardiovascular variability in major depressive disorder and effects of imipramine or mirtazapine (Org 3770). J Clin Psychopharmacol 1996; 16: 135-145
    CrossrefPubMedGoogle Scholar
  • 20 O’Regan C, Kenny RA, Cronin H et al. Antidepressants strongly influence the relationship between depression and heart rate variability: findings from The Irish Longitudinal Study on Ageing (TILDA). Psychol Med 2014; DOI: 10.1017/S0033291714001767:. 1-14
    PubMedGoogle Scholar
  • 21 Licht CM, de Geus EJ, van Dyck R et al. Association between anxiety disorders and heart rate variability in The Netherlands Study of Depress Anxiety (NESDA). Psychosom Med 2009; 71: 508-518
    CrossrefPubMedGoogle Scholar
  • 22 Licht CM, de Geus EJ, Seldenrijk A et al. Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension 2009; 53: 631-638
    CrossrefPubMedGoogle Scholar
  • 23 Koschke M, Boettger MK, Schulz S et al. Autonomy of autonomic dysfunction in major depression. Psychosom Med 2009; 71: 852-860
    CrossrefPubMedGoogle Scholar
  • 24 Bar KJ, Greiner W, Jochum T et al. The influence of major depression and its treatment on heart rate variability and pupillary light reflex parameters. J Affect Disord 2004; 82: 245-252
    CrossrefPubMedGoogle Scholar
  • 25 Roose SP, Laghrissi-Thode F, Kennedy JS et al. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. Jama 1998; 279: 287-291
    CrossrefPubMedGoogle Scholar
  • 26 Rechlin T, Weis M, Claus D. Heart rate variability in depressed patients and differential effects of paroxetine and amitriptyline on cardiovascular autonomic functions. Pharmacopsychiatry 1994; 27: 124-128
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Blumenthal JA, Sherwood A, Babyak MA et al. Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study. J Am Coll Cardiol 2012; 60: 1053-1063
    CrossrefPubMedGoogle Scholar
  • 28 Shea AK, Kamath MV, Fleming A et al. The effect of depression on heart rate variability during pregnancy. A naturalistic study. Clin Auton Res 2008; 18: 203-212
    CrossrefPubMedGoogle Scholar
  • 29 Glassman AH, Bigger JT, Gaffney M et al. Heart rate variability in acute coronary syndrome patients with major depression: influence of sertraline and mood improvement. Arch Gen Psychiatry 2007; 64: 1025-1031
    CrossrefPubMedGoogle Scholar
  • 30 Dai F, Lei Y, Chen JD. Inhibitory effects of desvenlafaxine on gastric slow waves, antral contractions, and gastric accommodation mediated via the sympathetic mechanism in dogs. Am J Physiol Gastrointest Liver Physiol 2011; 301: G707-G712
    CrossrefPubMedGoogle Scholar
  • 31 Terhardt J, Lederbogen F, Feuerhack A et al. Heart rate variability during antidepressant treatment with venlafaxine and mirtazapine. Clin Neuropharmacol 2013; 36: 198-202
    CrossrefPubMedGoogle Scholar
  • 32 Chang JS, Ha K, Yoon IY et al. Patterns of cardiorespiratory coordination in young women with recurrent major depressive disorder treated with escitalopram or venlafaxine. Prog Neuropsychopharmacol Biol Psychiatry 2012; 39: 136-142
    CrossrefPubMedGoogle Scholar
  • 33 Agelink MW, Majewski T, Wurthmann C et al. Effects of newer atypical antipsychotics on autonomic neurocardiac function: a comparison between amisulpride, olanzapine, sertindole, and clozapine. J Clin Psychopharmacol 2001; 21: 8-13
    CrossrefPubMedGoogle Scholar
  • 34 Kim JH, Yi SH, Yoo CS et al. Heart rate dynamics and their relationship to psychotic symptom severity in clozapine-treated schizophrenic subjects. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28: 371-378
    CrossrefPubMedGoogle Scholar
  • 35 Mueck-Weymann M, Rechlin T, Ehrengut F et al. Effects of olanzapine and clozapine upon pulse rate variability. Depress Anxiety 2002; 16: 93-99
    CrossrefPubMedGoogle Scholar
  • 36 Eschweiler GW, Bartels M, Langle G et al. Heart-rate variability (HRV) in the ECG trace of routine EEGs: fast monitoring for the anticholinergic effects of clozapine and olanzapine?. Pharmacopsychiatry 2002; 35: 96-100
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Malaspina D, Dalack G, Leitman D et al. Low heart rate variability is not caused by typical neuroleptics in schizophrenia patients. CNS Spectr 2002; 7: 53-57
    CrossrefPubMedGoogle Scholar
  • 38 Hempel RJ, Tulen JH, van Beveren NJ et al. Cardiovascular variability during treatment with haloperidol, olanzapine or risperidone in recent-onset schizophrenia. J Psychopharmacol 2009; 23: 697-707
    CrossrefPubMedGoogle Scholar
  • 39 Wang YC, Yang CC, Bai YM et al. Heart rate variability in schizophrenic patients switched from typical antipsychotic agents to amisulpride and olanzapine. 3-month follow-up. Neuropsychobiology 2008; 57: 200-205
    CrossrefPubMedGoogle Scholar
  • 40 Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002; 64: 258-266
    CrossrefPubMedGoogle Scholar
  • 41 Lee S, Creed FH, Ma YL et al. Somatic symptom burden and health anxiety in the population and their correlates. J Psychosom Res 2015; 78: 71-76
    CrossrefPubMedGoogle Scholar
  • 42 Lucock MP, Morley S. The health anxiety questionnaire. Brit J Health Psych 1996; 1: 137-150
    CrossrefPubMedGoogle Scholar
  • 43 Beck AT, Steer RA, Ball R et al. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996; 67: 588-597
    CrossrefPubMedGoogle Scholar
  • 44 Steer RA, Rissmiller DJ, Ranieri WF et al. Structure of the computer-assisted Beck Anxiety Inventory with psychiatric inpatients. J Pers Assess 1993; 60: 532-542
    CrossrefPubMedGoogle Scholar
  • 45 Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 11) S467-S472
    CrossrefPubMedGoogle Scholar
  • 46 Taylor JA, Carr DL, Myers CW et al. Mechanisms underlying very-low-frequency RR-interval oscillations in humans. Circulation 1998; 98: 547-555
    CrossrefPubMedGoogle Scholar
  • 47 Jain FA, Cook IA, Leuchter AF et al. Heart rate variability and treatment outcome in major depression: a pilot study. Int J Psychophysiol 2014; 93: 204-210
    CrossrefPubMedGoogle Scholar
  • 48 Kemp AH, Brunoni AR, Santos IS et al. Effects of depression, anxiety, comorbidity, and antidepressants on resting-state heart rate and its variability: an ELSA-Brasil cohort baseline study. Am J Psychiatry 2014; 171: 1328-1334
    CrossrefPubMedGoogle Scholar
  • 49 Agelink MW, Majewski TB, Andrich J et al. Short-term effects of intravenous benzodiazepines on autonomic neurocardiac regulation in humans: a comparison between midazolam, diazepam, and lorazepam. Crit Care Med 2002; 30: 997-1006
    CrossrefPubMedGoogle Scholar
  • 50 Unoki T, Grap MJ, Sessler CN et al. Autonomic nervous system function and depth of sedation in adults receiving mechanical ventilation. American journal of critical care: an official publication. Am J Crit Care 2009; 18: 42-50 quiz 51
    CrossrefPubMedGoogle Scholar