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Antidepressants and heart-rate variability in older adults: a population-based study

Published online by Cambridge University Press:  18 December 2015

R. Noordam ,
M. E. van den Berg ,
M. N. Niemeijer ,
N. Aarts ,
A. Hofman ,
H. Tiemeier ,
J. A. Kors ,
B. H. Stricker ,
M. Eijgelsheim  and
L. E. Visser
...Show all authors
R. Noordam
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
M. E. van den Berg
Affiliation:
Department of Medical Informatics, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
M. N. Niemeijer
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
N. Aarts
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
A. Hofman
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
H. Tiemeier
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
J. A. Kors
Affiliation:
Department of Medical Informatics, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
B. H. Stricker*
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Inspectorate of Health Care, Utrecht, The Netherlands
M. Eijgelsheim
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
L. E. Visser
Affiliation:
Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Apotheek Haagse Ziekenhuizen – HAGA, The Hague, The Netherlands
P. R. Rijnbeek
Affiliation:
Department of Medical Informatics, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
*
*Address for correspondence: B. H. Stricker, Mmed, Ph.D., Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands (Email: [email protected])
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Abstract

Background

Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may be associated with lower heart rate variability (HRV), a condition associated with increased mortality risk. We aimed to investigate the association between TCAs, SSRIs and HRV in a population-based study.

Method

In the prospective Rotterdam Study cohort, up to five electrocardiograms (ECGs) per participant were recorded (1991–2012). Two HRV variables were studied based on 10-s ECG recordings: standard deviation of normal-to-normal RR intervals (SDNN) and root mean square of successive RR interval differences (RMSSD). We compared the HRV on ECGs recorded during use of antidepressants with the HRV on ECGs recorded during non-use of any antidepressant. Additionally, we analysed the change in HRV on consecutive ECGs. Those who started or stopped using antidepressants before the second ECG were compared with non-users on two ECGs.

Results

We included 23 647 ECGs from 11 729 participants (59% women, mean age 64.6 years at baseline). Compared to ECGs recorded during non-use of antidepressants (n = 22 971), SDNN and RMSSD were lower in ECGs recorded during use of TCAs (n = 296) and SSRIs (n = 380). Participants who started using TCAs before the second ECG had a decrease in HRV and those who stopped had an increase in HRV compared to consistent non-users (p < 0.001). Starting or stopping SSRIs was not associated with HRV changes.

Conclusion

TCAs were associated with a lower HRV in all analyses, indicating a real drug effect. For SSRIs the results are mixed, indicating a weaker association, possibly due to other factors.

Keywords

Antidepressive agentselectrocardiographyepidemiologyheart-rate variabilitypopulation surveillance
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 6 , April 2016 , pp. 1239 - 1247
Copyright
Copyright © Cambridge University Press 2015 

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