Brief reportGastric dysmotility in patients with major depression
Introduction
Major depressive disorder (MDD) is known to influence the equilibrium of the autonomic nervous system (Yeragani et al., 2002, Moser et al., 1998, Bar et al., 2004). These patients often complain about a variety of vegetative symptoms such as disturbances of appetite, digestion, meteorism, sweating or constipation (Davidson and Turnbull, 1986). Anxiety is a common symptom of depression and is well known to occur in patients with irritable bowel syndrome (IBS) (Lydiard, 2001).
Autonomic dysfunction has been demonstrated in many studies investigating the influence of MDD on cardiac regulation (Bar et al., 2004, Boettger et al., 2008). A decreased parasympathetic and increased sympathetic function has been frequently suggested (Bar et al., 2004, Voss et al., 2006, Boettger et al., 2008). Yeragani et al. have found increased beat-to-beat QT variability in patients with depression as well as anxiety and it seems to be related to sympathetic function (Yeragani et al., 2000).
The enteric nervous system has not been studied in more detail in patients suffering from MDD although constipation is found in almost a third of depressed patients (Garvey et al., 1990).
Former reports have found some evidence of a prolongation of gut transit time in these patients (Gorard et al., 1996). Similarly, a high proportion of patients with intractable constipation suffered from a previous or current affective disorder (Dykes et al., 2001). Wu and colleagues have shown that dyspeptic patients with slightly dysthymic symptoms exhibit more dysrhythmic events of the gastric pacemaker by means of noninvasive electrogastrography (EGG; Wu et al., 2003). Several investigators have used the EGG to study conditions that have delayed gastric emptying such as diabetic gastroparesis or dyspepsia and have found that these are associated with tachygastria (Chen et al., 1993, Chen and McCallum, 1994a). Increased bradygastria indicated enhanced parasympathetic modulation in anorexia nervosa (Ogawa et al., 2004).
In the present study, we have investigated 21 unmedicated patients suffering from MDD by means of EGG to look for evidence of autonomic dysfunction within the enteric nervous system. We hypothesized that there is an increase in gastric sympathetic function in patients with MDD.
Section snippets
Subjects
We recruited 21 patients with major depressive disorder (MDD) and compared the EGG parameters of these patients with 21 healthy volunteers (sex- and age-matched). Patients admitted to our inpatient unit were diagnosed by a staff psychiatrist. To include patients into the study the patients had to meet DSM-IV criteria for MDD. All patients had not taken antidepressants for at least 8 weeks prior to hospital admission. Diagnosis was confirmed by means of a structured clinical interview for DSM-IV
Results
The MANOVA revealed a significant GROUP effect (F (34,7) = 2.5; p = 0.046) indicating an overall difference between patients and controls (Fig. 1 and Table 1). Tachygastria was the only parameter that was significantly different in patients before and after the test meal ingestion (F = 13.7; p < 0.001; Fig. 1B). Although we have observed only a trend for TIME (p < 0.052) for both groups, a significant GROUP × TIME interaction (F (34,7) = 3.74; p = 0.002) revealed differential changes of gastric
Discussion
The main finding of our study is the significantly increased amount of tachygastria. This suggests elevated sympathetic modulation in these patients. Tachygastria is assumed to arise due to additional external pacemaker activity (Jin et al., 2007, Hu et al., 1991) and correlates with gastric hypomotility (Qian et al., 2003, Chen et al., 2005). In previous studies, the autonomic function in depressed patients was evaluated by measuring the heart rate variability (HRV) (Agelink et al., 2001, Bar
Role of funding source
This study was funded by internal funds only.
Conflict of interests
None to declare.
Acknowledgements
The authors would like to thank Dr. R. Vollandt (IMSID, Institute for Medical Statistics, Friedrich-Schiller-University, Jena, Germany) for his advice on statistics.
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