Abstract
Twenty-four patients treated with 150 mg amitriptyline per day for an episode of major depression underwent a standardized heart rate analysis (HRA) before therapy and after 14 days. The battery of cardiovascular reflex tests included the determination of the coefficient of variation (CV) while resting and during deep respiration, a spectral analysis of heart rate, the heart rate response to standing, and the Valsalva manoeuvre. The results of the initial HRA did not differ from a group of 24 normal control subjects matched for age and sex. On day 14 of treatment the patients showed significantly reduced values of heart rate variability in all tests (P<0.0001), probably due to the anticholinergic side effects of amitriptyline. Heart rate increased form 78.1 to 93.6 bpm on average (P<0.0001). Abnormal CV at rest was registered in 96% of the patients; during deep respiration 29% showed abnormal CV results. An abnormal spectral analysis was found in 100% of the cases (low frequency peak: 42%, mid-frequency peak: 100%, high frequency peak: 79%). The heart rate response to standing was abnormal in 75% and the Valsalva test in 33% of the cases. Eighty-eight percent of the patients fulfilled the criteria of a cardiovascular autonomic neuropathy under the conditions of amitriptyline therapy. As yet, the consequences of these changes for the patients have not been sufficiently elucidated.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Akselrod S, Gordon D, Ubel FA, Shannon DC, Barger AC, Chen RJ (1981) Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 213:220–222
Avery D, Winokur G (1976) Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatry 33:1029–1037
Dalack GW, Roose SP (1990) Perspectives on the relationship between cardiovascular disease and affective disorder. J Clin Psychiatry 51 [7 (Suppl)]: 4–9
Ewing DJ (1991) Heart rate variability: an important new risk factor in patients following myocardial infarction. Clin Cardiol 14:683–685
Ewing DJ, Campbell IW, Clarke BF (1980) Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Int Med 92:308–311
Glassman AH, Roose SP, Walsh BT (1992) Antidepressants in the cardiac patient. Clin Neuropharmacol 15 [Suppl 1 Pt A]: 640 A-641 A
Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62
Jakobsen J, Hauksson P, Vestergaard P (1984) Heart rate variation in patients treated with antidepressants. An index of anticholinergic effects? Psychopharmacology 84:544–548
Kristensen E, Jakobsen J, Bartels U, Vestergaard P (1989) Cholinergic dysfunction of heart, pupil, salivary glands, and urinary bladder in healthy volunteers during long-term treatment with clomipramine. Psychopharmacology 89:398–402
Langhorst P, Schulz G, Lambertz M (1984) Oscillating neuronal network of the “common brainstem system”. In: Miyakawa et al. (eds) Mechanism of blood pressure waves. Springer, Berlin, pp 257–275
Lishner M, Akselrod S, Mor Avi V, Oz O, Divon M, Ravid M (1987) Spectral analysis of heart rate fluctuations. A non-invasive, sensitive method for the early diagnosis of autonomic neuropathy in diabetes mellitus. J Auton Nerv Syst 19:119–125
Low PA (1993) Autonomic nervous system function. J Clin Neurophysiol 10:14–27
Low PA, Opfer-Gehrking TL (1992) Differential effects of amitriptyline on sudomotor, cardiovagal, and adrenergic function in human subjects. Muscle Nerve 15:1340–1344
Low PA, Pfeifer MA (1993) Standardization of clinical tests for practice and clinical trials. In: Low PA (ed) Clinical autonomic disorders. Little, Brown & Company, Boston, Toronto, London, pp 287–296
Mackay JD (1983) Respiratory sinus arrhythmia in diabetic neuropathy. Diabetologia 24:253–256
O'Brien IA, McFadden JP, Corrall RJM (1991) The influence of autonomic neuropathy on mortality in insulin-dependent diabetes. Q J Med 79 [No. 290]: 495–502
Pomeranz B, Macaulay RJB, Caudill MA, Kutz I, Adam D, Gordon D (1985) Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol 248:H151-H153
Rechlin T, Weis M, Claus D (1994) Heart rate variability in depressed patients and differential effects of paroxetine and amitriptyline on cardiovascular autonomic function. Pharmacopsychiatry (in press)
Rich MW, Saini JS, Kleiger RE, Carney RM, teVelde A, Freedland KE (1988) Correlation of heart rate variability with clinical and angiographic variables and late mortality after coronary angiography. Am J Cardiol 62:714–717
Spyer KM (1988) Central nervous system control of the cardiovascular system. In: Bannister R (ed) Autonomic failure: a text book of clinical disorders of the autonomic nervous system. Oxford University Press, Oxford, pp 56–79
Thorogood M, Cowen P, Mann J, Murphy M, Vessey M (1992) Fatal myocardial infarction and use of psychotropic drugs in young women. Lancet 340:1067–1068
Weinberg CR, Pfeifer MA (1984) An improved method for measuring heart-rate variability: assessment of cardiac autonomic function. Biometrics 40:855–861
Yeragani VK, Pohl R, Balon R, Ramesh C, Glitz D, Jung I, Sherwood P (1992a) Heart rate variability in patients with major depression. Psychiatry Res 37:35–46
Yeragani VK, Pohl R, Ramesh C, Glitz D, Weinberg P, Merlos B (1992b) Effect of imipramine treatment on heart rate variability measures. Neuropsychobiology 26:27–32
Ziegler D, Laux G, Dannehl K, Spüler M, Mühlen H, Mayer P, Gries FA (1992a) Assessment of cardiovascular autonomic function: agerelated normal ranges and reproducibility of spectral analysis, vector analysis and standard tests of heart rate variation and blood pressures responses. Diabet Med 9:166–175
Ziegler D, Gries FA, Spüler M, Lessmann F (1992b) The epidemiology of diabetic neuropathy. J Diabet Complic 6:49–57
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rechlin, T., Claus, D. & Weis, M. Heart rate analysis in 24 patients treated with 150 mg amitriptyline per day. Psychopharmacology 116, 110–114 (1994). https://doi.org/10.1007/BF02244880
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02244880