Effect of fluoxetine and psychotherapy on heart rate variability in children and adolescents diagnosed with panic disorder: 24-hour Holter monitoring study before and after treatment [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2019; 47(6): 458-465 | DOI: 10.5543/tkda.2019.92646

Effect of fluoxetine and psychotherapy on heart rate variability in children and adolescents diagnosed with panic disorder: 24-hour Holter monitoring study before and after treatment

Mustafa Argun1, Hesna Gul2, Selahattin Çelebı3, Ferhan Elmalı4, Nazmi Narin5
1Department of Pediatric Cardiology, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
2Department of Pediatric Psychiatry, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
3Department of Pediatrics, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
4Department of Biostatistics and Medical Informatics, Erciyes University Faculty of Medicine, Kayseri, Turkey
5Department of Pediatric Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey


OBJECTIVE
Panic disorder (PD) is now recognized as a common and important problem in children, and particularly adolescents, and one that can negatively affect daily well-being and educational performance. The aim of this study was to investigate the relationship between heart rate variability (HRV) and the severity of symptoms before and after treatment with psychotherapy and fluoxetine.

METHODS
The PD study group consisted of 23 children diagnosed with PD and the healthy control (HC) group comprised 27 healthy children. Panic-anxiety symptoms were measured using 2 assessments performed before and after treatment. HRV was evaluated with a 24-hour Holter examination.

RESULTS
According to the analysis of the 24-hour, all-day Holter device recordings, the high frequency (HF) and parasympathetic (%) scores in the PD group were lower than those of the HC group (p<0.05). The low frequency (LF)/HF ratio and sympathetic (%) scores in the PD group were higher than those of the HC group (p<0.05). The analysis of daytime readings indicated that the HF values of the PD group were lower than those of the HC group (p<0.05), while the very LF/HF ratio and LF/HF ratio were higher than those of the HC group (p<0.05). Analysis of nighttime Holter results revealed that the rMSSD, pNN50, and HF readings of the PD group were lower than those of the HC group (p<0.05), while the LF/HF ratio in PD patients was higher than that seen in the HC group (p<0.05).

CONCLUSION
In children and adolescents with PD, increased sympathetic activity can cause changes in some HRV parameters. Some of these changes may return to normal with treatment.

Keywords: Adolescent, fluoxetine; heart rate variability; panic disorder; psychotherapy.

How to cite this article
Mustafa Argun, Hesna Gul, Selahattin Çelebı, Ferhan Elmalı, Nazmi Narin. Effect of fluoxetine and psychotherapy on heart rate variability in children and adolescents diagnosed with panic disorder: 24-hour Holter monitoring study before and after treatment. Turk Kardiyol Dern Ars. 2019; 47(6): 458-465

Corresponding Author: Mustafa Argun, Türkiye
© Copyright 2019 Archives of the Turkish Society of Cardiology
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