depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients implications for cardiovascular risk抑郁、共病焦虑障碍和心率变异性在身体健康,如此病人对心血管风险的影响.pdfVIP

Depression, Comorbid Anxiety Disorders, and Heart Rate Variability in Physically Healthy, Unmedicated Patients: Implications for Cardiovascular Risk 1 1 2 3 4,5 Andrew H. Kemp *, Daniel S. Quintana , Kim L. Felmingham , Slade Matthews , Herbert F. Jelinek 1 School of Psychology, University of Sydney, Sydney, New South Wales, Australia, 2 School of Psychology, University of New South Wales, Sydney, New South Wales, Australia, 3 School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia, 4 Centre for Research in Complex Systems, Charles Sturt University, Albury, New South Wales, Australia, 5 Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia Abstract Context: There is evidence that heart rate variability (HRV) is reduced in major depressive disorder (MDD), although there is debate about whether this effect is caused by medication or the disorder per se. MDD is associated with a two to fourfold increase in the risk of cardiac mortality, and HRV is a robust predictor of cardiac mortality; determining a direct link between HRV and not only MDD, but common comorbid anxiety disorders, will point to psychiatric indicators for cardiovascular risk reduction. Objective: To determine in physically healthy, unmedicated patients whether (1) HRV is reduced in MDD relative to controls, and (2) HRV reductions are driven by MDD alone, comorbid generalized anxiety disorder (GAD, characterized by anxious anticipation), or comorbid panic and posttraumatic stress disorders (PD/PTSD, characterized by anxious arousal). Design, Setting, and Patients: A case-control study in 2006 and 2007 on 73 MDD patients, including 24 without anxiety comorbidity, 24 with GAD, and 14 with PD/PTSD. Sev