Neurophysiologic Tests during Antidepressive Treatment - an Exploratory Study

This is a non-randomized exploratory study showing the sensitivity of neurophysiological parameters for autonomic side-effects during the application of antidepressant drugs. Inpatients on tricyclic antidepressants (TCA: amitriptyline or doxepine), inpatients on serotonine-reuptake inhibitors (SSRI: fluvoxamine or paroxetin) and a control group of healthy volunteers underwent neurophysiological examination. The treatment group was investigated after at least 7 days of continuous treatment with the final dose. Adjustment of the autonomic nervous system was studied, first, by measuring latency and amplitude of the sympathetic skin response (SSR), elicited by electric stimuli and by deep inspiration, and second, by analysis of the heart rate variation (HRV) during rest and inspiration. Relevant affections of the peripheral parts of the reflex arc under discussion were excluded by taking the nerve conduction velocity (NCV) and F-wave referring to cervical segment C7. In total, 48 individuals were examined. The TCA group showed delayed latencies and smaller amplitudes of the SSR in comparison with the controls. In the SSRI group, these parameters did not differ significantly from those of the controls. Analysis of HRV put further emphasis on the impaired adjustment of the autonomic nervous system in the TCA group. To sum up, our test battery indicated a specific vegetative alteration due to TCA.

References

• 1 Bavry J L. Design Power. Statistical Design Analysis System. Scientific Software Inc 1987
• 2 Beck A T, Steer R A, Garbin M G. Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation.  Clin Psychol Rev. 1988;  8 77-100
• 3 Ferreres F, Bertsch G, Baumann P. Antidepressant treatment before hospitalization for major depression: often prescribed, often undertitrated.  Pharmacol Res. 1997;  35 ((1)) 33-36
• 4 Kaplan E M. Antidepressant noncompliance as a factor for the discontinuation syndrome.  J Clin Psychiatry. 1997;  58 ((Suppl. 7)) 31-35
• 5 Levy D M, Reid G, Rowley D A, Abraham R R. Quantitative measures of sympathetic skin response in diabetes: relation to sudomotor and neurological function.  J Neurol Neurosurg Psychiatry. 1992;  55 902-908
• 6 Liu B, Anderson G, Mittmann N, To T, Axcell T, Shear N. Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people.  Lancet. 1998;  351 1303-1307
• 7 Rechlin T, Weis M, Claus D. Heart Rate Variability in Depressed Patients and Differential Effects of Paroxetin and Amitryptiline on Cardiovascular Autonomic Functions.  Pharmacopsychiat. 1994;  27 124-128
• 8 Revicki D A, Brown R E, Keller M B, Gonzales J, Culpepper L, Hales R E. Cost-effectiveness of newer antidepressants compared with tricyclic antidepressantsin managed care settings.  J Clin Psychiatry. 1997;  58 ((2)) 47-58
• 9 Sattler H D, Dech H, Sandermann S, Kick H. Somatization and Side Effects of tricyclic Antidepressants and Serotonine Reuptake Inhibitors - a neurophysiological and psychometrical Investigation.  European Psychiatry. 1996;  11 ((Suppl. 4)) 329
• 10 Schwalen S, Jörg J. Peripher autonome Potentiale: Normwerte unter verschiedenen Bedingungen.  Z EEG-EMG. 1993;  24 242-246
• 11 Shahani B T, Halperin J J, Boulu P, Cohen J. Sympathetic skin response - a method of assessing unmyelinated axon dysfunction in peripheral neurpathies.  J Neurol Neurosurg Psychiatry. 1984;  47 536-542
• 12 Stuart S, Wright J H, Thase M E, Beck A T. Cognitive therapy with inpatients.  Gen-Hosp-Psychiatry. 1997;  19 ((1)) 42-50
• 13 Thapa P B, Gideon P, Cost T W, Milam A B, Ray W A. Antidepressants and the risk of falls among nursing home residents.  N Engl J Med. 1998;  339 975-882
• 14 von Zerssen D. Die Beschwerdeliste als Test.  Therapiewoche. 1971;  21 1908-1914