The effect of sertraline on Autonomic Nervous System (ANS) regulation in post myocardial infarction

Background: This is a clinical physiologic study to demonstrate whether low heart rate variability (HRV) in post myocardial infarction (MI) subjects can be augmented by a pharmacologic intervention with a selective serotonin reuptake inhibitor (SSRI). Methods: Subjects with acute MI who met criteria for depression were randomised to receive either sertraline or placebo (double blind) and then followed for six months. During that time autonomic testing, clinical data and psychometric tests were performed on a monthly basis. Over a three year period 27 such subjects were recruited to the randomised control trial (RCT). Individual growth curve analysis have been plotted and compared between the two depressed groups to assess the effect of the SSRI on the degree and rate of recovery of sympatho-vagal balance. The recovery curve of HRV for a non-depressed post MI cohort serves as a comparison to the RCT cohorts. Results: Findings confirm a significant difference - p=.001 in rate and degree of recovery of HRV in the sertraline group as compared with the placebo group. Conclusion: An SSRI has a regulatory effect on the ANS resulting in a return in balance of sympathetic and vagal effects on heart functioning.