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Correspondence| Volume 71, ISSUE 7, e27-e28, April 01, 2012

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Are Antidepressants Good for the Soul but Bad for the Matter? Using Noninvasive Brain Stimulation to Detangle Depression/Antidepressants Effects on Heart Rate Variability and Cardiovascular Risk

Published:December 05, 2011DOI:https://doi.org/10.1016/j.biopsych.2011.08.026
      Heart rate variability (HRV) is an electrocardiograph-based technique that assesses sympathovagal activity over the heartbeat. Lower HRV (i.e., low power in the low frequency of the power spectral analysis) has been associated with an increased risk for myocardial infarction (
      • Buccelletti E.
      • Gilardi E.
      • Scaini E.
      • Galiuto L.
      • Persiani R.
      • Biondi A.
      • et al.
      Heart rate variability and myocardial infarction: Systematic literature review and metanalysis.
      ) and other cardiovascular conditions and thus is a biomarker for cardiac illness. Two articles recently published in Biological Psychiatry showed that lower HRV is observed in major depressive disorder (MDD). However, whereas the meta-analysis of Kemp et al. (
      • Kemp A.H.
      • Quintana D.S.
      • Gray M.A.
      • Felmingham K.L.
      • Brown K.
      • Gatt J.
      Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis.
      ) showed that this was associated more robustly with MDD severity, the longitudinal study of Licht et al. (
      • Licht C.M.
      • de Geus E.J.
      • van Dyck R.
      • Penninx B.W.
      Longitudinal evidence for unfavorable effects of antidepressants on heart rate variability.
      ) observed that antidepressants were associated with lower HRV and their withdrawal with HRV increasing, therefore suggesting that they could play a key role for diminished vagal control over the heart of MDD treated patients. Because such patients present increased cardiovascular burden (
      • Pizzi C.
      • Manzoli L.
      • Mancini S.
      • Costa G.M.
      Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function.
      ), it is mandatory to investigate whether antidepressants might decrease HRV and whether this contributes to such elevated cardiovascular risk.
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