Cardiovascular tests of autonomic function and sympathetic skin responses in patients with major depression.

Abstract

To assess the function of the autonomic nervous system in major depression, a series of cardiovascular tests, together with the recording of sympathetic skin response, were performed in 18 depressed patients (melancholic type, DSM-III-R criteria) and in 18 healthy control subjects. Depressed patients showed significantly poorer performance in Valsalva's, deep breathing, and lying to standing manoeuvres than controls, indicating an impairment of parasympathetic function. Depressed patients developed a significantly larger sympathetic skin response than controls during the lying to standing and hand grip manoeuvres, whereas cardiovascular sympathetic performance (as assessed by the responses to hand grip, cold, mental arithmetic, explosive sound, or hyperventilation) was similar in both groups. The results are compatible with the view that a diminished parasympathetic reactivity, and presumably an increased sympathetic reactivity, occur in patients with major depression. (7 Neurol Neurosurg Psychiatry 1995;58:299-302)

Autonomic Dysfunction in Major Depressive Disorder

“…[11][12][13] In this study, significantly lower total power, HF power and HF norm and significantly higher LF norm in both drug naive and medicated depressed patients compared to control suggest lower parasympathetic and higher sympathetic drive and higher LH/HF ratio as index of sympathovagal imbalance in MDD patients. Similar observations were also made by some researchers 8,[16][17] . Several other researchers observed similar trends but it was not statistically significant .…”

Effects of Antidepressants, but not Psychopathology, on Cardiac Sympathetic Control: A Longitudinal Study

“…mental health-care practice, reflects the general population of depressed and anxiety patients. Several reports using different SNS indices also found increased sympathetic activity in depressed or anxious subjects (Esler et al, 1982;Gold et al, 2005;Guinjoan et al, 1995;Light et al, 1998;Koschke et al, 2009). These previous reports focused on general sympathetic activity, whereas we measured sympathetic control more narrowly by its effects on cardiac contractility.…”

“…These previous reports focused on general sympathetic activity, whereas we measured sympathetic control more narrowly by its effects on cardiac contractility. Guinjoan et al (1995) described a higher sympathetic skin response in 18 melancholically depressed patients compared with 18 healthy controls. Gold et al (2005), reported higher plasma NE levels in 10 subjects with severe melancholic depression than in 12 healthy controls.…”

“…This limitation is balanced by strong points: this is the first longitudinal study with a large enough sample to separate antidepressant effects from those of the psychiatric condition per se, by including healthy controls and subjects with depressive and/or anxiety disorders not using antidepressants as well as subjects using different types of antidepressants. Previous studies were much smaller, simply excluded antidepressant users (Koschke et al, 2009;Light et al, 1998) or applied antidepressant washout periods before testing that may have been too short (10 day-2 weeks) (Esler et al, 1982;Guinjoan et al, 1995).…”

“…Various studies reported increased sympathetic activity in depressed and anxious subjects compared with healthy controls, measured by different indices like spillover of norepinephrine (NE) and epinephrine (EPI), skin conductance responses, QT interval variability (QTvi), or the pre-ejection period (PEP) (Light et al, 1998;Esler et al, 1982;Guinjoan et al, 1995;Gold et al, 2005;Koschke et al, 2009;Barton et al, 2007). However, other studies reported no association between psychopathology and SNS activity or reported decreased SNS activity in subjects with depressive or anxiety disorders (Wilkinson et al, 1998;Esler et al, 2004;Roth et al, 2008;Ahrens et al, 2008), so findings remain inconclusive.…”