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Depression

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Clinical Autonomic Dysfunction

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Abstract

Depression is associated with parasympathetic excess (PE), whether at rest or during Valsalva or stand. Typically, Valsalva or stand PE is associated with unstable patients, including difficult to control BP, blood glucose, or hormone level, and stand PE can mask sympathetic withdrawal (SW) which is associated with orthostatic dysfunction. In cases of depression, Valsalva or stand PE often involves depression with anxiety, high BP, pain, or hyperactivity, i.e., bipolar, manic depression, anxiety, hypertension with depression, chronic regional pain syndrome, fibromyalgia, chronic fatigue, or attention-deficit disorder with or without hyperactivity. Physiologically, the PE amplifies the sympathetic response, causing a seemingly normal individual at rest to react excessively. Since the sympathetic nervous system is the reactionary nervous system, it should not be surprising that the Valsalva or stand PE is the primary autonomic disorder. Treating the PE enables the sympathetics to react less excessively, normalizing those responses, thereby normalizing BP or other responses. Stand PE masking SW helps to document and treat dizzy hypertensives. Resting PE is associated with clinical or subclinical depression and is the PE that elevates mortality risk in heart disease patients.

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Authors and Affiliations

  1. Autonomic Laboratory Department of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA

    Joseph Colombo PhD

  2. ANSAR Medical Technologies, Inc., Philadelphia, PA, USA

    Joseph Colombo PhD

  3. Department of Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  4. Department of Cardiology, The Chicago Medical School, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  5. Department of Cardiology, Hahnemann Hospital Drexel University College of Medicine, Philadelphia, PA, USA

    Nicholas L. DePace MD, FACC

  6. Department of Medicine, Eastern Virginia Medical School Strelitz Diabetes Research Center, Norfolk, VA, USA

    Aaron I. Vinik MD, PhD, FCP, MACP

Authors
  1. Joseph Colombo PhD
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  2. Rohit Arora MD, FACC, FAHA, FACP, FSCAI
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  3. Nicholas L. DePace MD, FACC
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  4. Aaron I. Vinik MD, PhD, FCP, MACP
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© 2015 Springer International Publishing Switzerland

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Colombo, J., Arora, R., DePace, N.L., Vinik, A.I. (2015). Depression. In: Clinical Autonomic Dysfunction. Springer, Cham. https://doi.org/10.1007/978-3-319-07371-2_16

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  • DOI: https://doi.org/10.1007/978-3-319-07371-2_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07370-5

  • Online ISBN: 978-3-319-07371-2

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