Major depression, heart rate, and plasma norepinephrine in patients with coronary heart disease

Background: Although it is now well established that psychiatric depression is associated with adverse outcomes in patients with coronary heart diseas e (CHD), the mechanism underlying this association is unclear. Elevated hea rt rate (HR) and plasma norepinephrine (NE), possibly reflecting altered au tonomic nervous system activity, have been documented in medically well dep ressed psychiatric patients, and this pattern is associated with increased risk for cardiac events in patients with CHD. The purpose of this study was to determine,whether autonomic nervous system activity is altered in depre ssed CHD patients. Methods: HR, plasma NE, and blood pressure (BP) were measured in 50 depress ed and 39 medically comparable nondepressed CHD patients at rest and during orthostatic challenge. Results: Resting HR (p =.005), and the change from resting HR at 2, 5, and 10 min after standing (p = 02, .004, and .02, respectively), were significa ntly higher in the depressed than in the nondepressed patients. There were no differences between the groups in NE or in BP at rest, or in standing mi nus resting change scores at any time during orthostatic challenge (p > .05 ). Conclusions: Depression is associated with altered autonomic activity in pa tients with CHD, as reflected by elevated vesting HR and an exaggerated HR response to orthostatic challenge, Previously reported differences in NE le vels between depressed and nondepressed patients were not replicated. (C) 1 999 Society of Biological Psychiatry.