Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures

Background Studies have linked depression to sudden death and serious cardiovascular events in patients with preexisting cardiac illness. Recent studies have shown decreased vagal function in cardiac patients with depression and depressed patients without cardiac illness. Methods We compared 20-hour, sleeping, and awake heart period variability measures using spectral analysis, fractal dimension, and symbolic dynamics in two patient groups with major depression and ischemic heart disease (mean age 59–60 years) before and after 6 weeks of paroxetine or nortriptyline treatment. Results Spectral measures showed decreases in awake and sleeping total power (TP: 0.0–0.5 Hz), ultra low frequency power (ULF: 0–0.0033 Hz), very low frequency power (VLF: 0.0033–0.04 Hz), and low-frequency power (LF: 0.04–0.15 Hz) for nortriptyline condition and a decrease in high-frequency power (HF: 0.15–0.5 Hz) for the awake condition in patients who received nortriptyline. A measure of nonlinear complexity, WC-100, significantly increased after paroxetine during the awake condition. Conclusions These findings suggest that nortriptyline has stronger vagolytic effects on cardiac autonomic function compared with paroxetine, which is in agreement with previous clinical and preclinical reports. Paroxetine may have some cardio-protective effects, especially in cardiac patients.