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Higher Effect On Cardiac Autonomic Function With Nortriptyline Than Paroxetine
A DGReview of :"Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures"
Biological Psychiatry
10/23/2002
By Harvey McConnell
Nortriptyline has stronger vagolytic effects on cardiac autonomic function compared with paroxetine, clinicians have found in a study among patients with major depression and ischemic heart disease.
Paroxetine may have some cardioprotective effects, especially in cardiac patients, suggest researchers at the departments of psychiatry at Wayne State University School of Medicine, Detroit, Michigan, and Columbia University School of Medicine, New York, New York, United States.
The clinicians point out that earlier studies have linked depression to sudden death and serious cardiovascular events in patients with pre-existing cardiac illness. More recent studies have found decreased vagal function in cardiac patients with depression and depressed patients who do not have any cardiac illness.
In the current study, the clinicians assessed the 20-hour sleeping and awake heart period variability measures using spectral analysis, fractal dimension, and symbolic dynamics. They compared two groups of patients, with a mean age between 59 and 60, who had major depression and ischaemic heart disease.
The patients were assessed both before and after they had a six week course of either paroxetine or nortriptyline treatment.
Spectral measures showed among those who received nortriptyline decreases in awake and sleeping total power, ultra low frequency power, very low frequency power, and low-frequency power. There was a decrease in high-frequency power for the awake condition in patients who received nortriptyline.
At the same time, a measure of nonlinear complexity, WC-100, significantly increased after among patients receiving paroxetine during the time they were awake.
Clinicians say their findings suggesting that nortriptyline has stronger vagolytic effects on cardiac autonomic function compared to paroxetine, are in line with previous pre-clinical and clinical reports.
Biological Psychiatry; Volume 52, Issue 5, pp 418-429.
"Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures"
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