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Importance of current research is determined by the need to find the clinical and functional evaluation criteria for the systemic patterns of changes in physiological reactivity of the patient at various stages depression treatment.
Optimization of diagnostics and planning of treatment of patients with depression based on analysis psychopathological state and autonomic reactivity during active treatment using SSRI antidepressants.
System analyze of clinical-psychopathological characteristics and autonomic reactivity of major depression. Main group included 62 patients with the diagnosis of depressive episode. Control group: 64 healthy persons.
Clinico- psychopathological, clinico- anamnestic, Hamilton Depression Rating Scale (HDRS-17), the analysis of heart rate variability for investigation of autonomic regulation.
Results of the depressive patients autonomic regulation study show the reduction of total heart rate variability is observed at rest and in orthostatic test. The balance of sympathetic, parasympathetic and suprasegmental parts of autonomic nervous system was preserved at rest in depression. However after orthostatic test the activity of sympathetic baroreflex mechanisms is decreased and the hyperactivation of suprasegmental ergotropic systems is revealed. During the 4–6-weeks treatment the positive dynamics of psychopathological characteristics is observed but the changes of autonomic reactivity are not revealed. After 6-months therapy only 30, 6% of patients demonstrate signs of normalisation of autonomic regulation.
Obtained data, apparently, attest to the fact that the emotional and autonomic symptoms are restored with different speed. The results of study should be used in the planning of treatment in the psychiatric practice and in the primary medical care.
Investigation of the pathogenesis mechanisms in depression remains an actual task of modern psychiatry.
The analysis of clinical-psychopathological characteristics, functional activity of autonomic nervous system and endogenous opioid system in endogenomorphic depression. the main group included 72 patients diagnosed with depressive episode.
Clinico- psychopathological, clinico-anamnestic, Hamilton Depression Rating Scale (HDRS-17), the analysis of heart rate variability (HRV) for evaluation of autonomic regulation. in 9 patients plasma levels of beta-endorphin were obtained. Patients were investigated 3 times - at baseline, and then during 2nd–3d and 4th–6th weeks of antidepressant therapy.
The reduction of total HRV was observed at rest and in orthostatic test during evaluation of autonomic regulation in depressive patients. the hyperactivation of suprasegmental ergotropic systems was observed in depressive patients before treatment. in responders subgroup despite on positive dynamics of clinico-psychopathological and psychometric characteristics, in the 2nd–3d week of therapy increase in general HRV was observed, in the 4th–6th week parameters come back to baseline level. the balance of sympathetic, parasympathetic and suprasegmental parts of autonomic nervous system did not change. the plasma endorphin levels were rising to 2nd–3d treatment week, and come back to baseline level at the 4th–6th treatment week.
Obtained data confirm evidence that the therapeutic dynamics of depression is characterized by a faster reduction of clinical symptoms, whereas changes in functional activity of stress-realizing and stress-limiting mechanisms can be kept much longer.
This research is supported by grant provided by Russian Humanitarian Research Foundation project 11-06-00869а
The knowledge on brain mechanisms of psychopathology can be very useful for the diagnosis and treatment of patients.
Patients with major depressive disorder (MDD) show attention bias to the negative emotional stimuli. Automatic (unconscious) emotional processing in such patients may become a prospective biomarker for depression.
We aimed at studying the EEG-correlates of unconscious expectation of angry human faces in MDD patients compared to healthy controls.
128-channel EEG was recorded in MDD (23 females and 7 males) and in healthy volunteers (22 females and 8 males) while they categorized pictures as humans or animals. Half of the pictures were neutral and half were showing the faces of angry humans or animals. The pictures were preceded by cues (one for each category), which meaning was not explained to the participants. We performed the wavelet analysis on EEG recorded during the face expectation period: 1000–2000 ms from the cue onset.
We found the emotional modulation (EM) in EEG rhythms during the expectation of angry vs. neutral faces in both groups. Statistical comparison of the spectral power using 2 × 2 factorial design showed that the EM differences (P < 0.05) between the groups were in the left parietal locations in 9 Hz and in 16–18 Hz, in the right parietal locations in 27–28 Hz, and in the right frontal area in 30–31 Hz.
The unconscious expectation of angry vs. neutral faces resulted in EM differences between the MDD and healthy controls in the right frontal and bilateral parietal areas mostly in beta and gamma ranges.
Disclosure of interest
The authors have not supplied their declaration of competing interest.