From the Journal of the American Heart Association, 3 September 2013.
Original Research
Coronary Heart Disease
Effects of Norepinephrine Reuptake Inhibition on Postural Tachycardia Syndrome
Elizabeth A. Green, BEng; Vidya Raj, MB, ChB; Cyndya A. Shibao, MD, MSCI; Italo Biaggioni, MD; Bonnie K. Black, RN, CNP; William D. Dupont, PhD; David Robertson, MD; Satish R. Raj, MD, MSCI
Correspondence to:
Satish R. Raj, MD, MSCI, FACC, FHRS, AA3228 Medical Center North, Vanderbilt University, 1161 21st Avenue South, Nashville, TN 37232‐2195. E‐mail: satish.raj@vanderbilt.edu
Abstract
Background Postural tachycardia syndrome (POTS) is a disorder of chronic orthostatic intolerance accompanied by excessive orthostatic tachycardia. Patients with POTS commonly have comorbid conditions such as attention deficit hyperactivity disorder, depression, or fibromyalgia that are treated with medications that inhibit the norepinephrine reuptake transporter (NRI). NRI medications can increase sympathetic nervous system tone, which may increase heart rate (HR) and worsen symptoms in POTS patients. We sought to determine whether NRI with atomoxetine increases standing tachycardia or worsens the symptom burden in POTS patients.
Methods and Results Patients with POTS (n=27) underwent an acute drug trial of atomoxetine 40 mg and placebo on separate mornings in a randomized, crossover design. Blood pressure (BP), HR, and symptoms were assessed while seated and after standing prior to and hourly for 4 hours following study drug administration. Atomoxetine significantly increased standing HR compared with placebo (121±17 beats per minute versus 105±15 beats per minute; P=0.001) in POTS patients, with a trend toward higher standing systolic BP (P=0.072). Symptom scores worsened with atomoxetine compared to placebo (+4.2 au versus −3.5 au; P=0.028) from baseline to 2 hours after study drug administration.
Conclusion Norepinephrine reuptake inhibition with atomoxetine acutely increased standing HR and symptom burden in patients with POTS.
Clinical Trials Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00262470.
From PLoS One, 26 August 2013.
Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis.
Lakhan SE, Schofield KL.
Global Neuroscience Initiative Foundation, Los Angeles, California, United States of America.
Abstract
BACKGROUND
Mindfulness-based therapy (MBT) has been used effectively to treat a variety of physical and psychological disorders, including depression, anxiety, and chronic pain. Recently, several lines of research have explored the potential for mindfulness-therapy in treating somatization disorders, including fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome.
METHODS
Thirteen studies were identified as fulfilling the present criteria of employing randomized controlled trials to determine the efficacy of any form of MBT in treating somatization disorders. A meta-analysis of the effects of mindfulness-based therapy on pain, symptom severity, quality of life, depression, and anxiety was performed to determine the potential of this form of treatment.
FINDINGS
While limited in power, the meta-analysis indicated a small to moderate positive effect of MBT (compared to wait-list or support group controls) in reducing pain (SMD = -0.21, 95% CI: -0.37, -0.03; p<0.05), symptom severity (SMD = -0.40, 95% CI: -0.54, -0.26; p<0.001), depression (SMD = -0.23, 95% CI: -0.40, -0.07, p<0.01), and anxiety (SMD = -0.20, 95% CI: -0.42, 0.02, p = 0.07) associated with somatization disorders, and improving quality of life (SMD = 0.39, 95% CI: 0.19, 0.59; p<0.001) in patients with this disorder. Subgroup analyses indicated that the efficacy of MBT was most consistent for irritable bowel syndrome (p<0.001 for pain, symptom severity, and quality of life), and that mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MCBT) were more effective than eclectic/unspecified MBT.CONCLUSIONS Preliminary evidence suggests that MBT may be effective in treating at least some aspects of somatization disorders. Further research is warranted.
From the Journal of Epidemiology and Community Health, 10 September 2013. (Epub ahead of print).
The prospective association between childhood cognitive ability and somatic symptoms and syndromes in adulthood: the 1958 British birth cohort.
Kingma EM, Rosmalen JG, White PD, Stansfeld SA, Clark C.
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands.
Abstract
BACKGROUND
Cognitive ability is negatively associated with functional somatic symptoms (FSS) in childhood. Lower childhood cognitive ability might also predict FSS and functional somatic syndromes in adulthood. However, it is unknown whether this association would be modified by subjective and objective measures of parental academic expectations.
METHODS
14 068 participants from the 1958 British birth cohort, whose cognitive ability was assessed at 11 years. Outcomes were somatic symptoms at 23, 33 and 42 years. Self-reported irritable bowel syndrome (IBS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and operationally defined CFS-like illness were measured at 42 years.
RESULTS
Lower cognitive ability at age 11 years was associated with somatic symptoms at ages 23, 33 and 42 years. Adjusting for sex, childhood internalising problems, previous somatic symptoms and concurrent psychological symptoms, childhood cognitive ability remained negatively associated with somatic symptoms at age 23 years (β=-0.060, 95% CI -0.081 to -0.039, p<0.01), 33 years (β = -0.031, 95% CI -0.050 to -0.011, p<0.01), but not with somatic symptoms at 42 years.Overall, we found no clear association between lower childhood cognitive ability and CFS/ME, CFS-like illness and IBS. Associations between cognitive ability and somatic symptoms at 23 years were moderated by low parental social class, but not by subjective indicators of parental academic expectations.CONCLUSIONSLower childhood cognitive ability predicted somatic symptoms, but not CFS/ME, CFS-like illness and IBS in adulthood. While earlier research indicated an important role for high parental academic expectations in the development of early-life FSS, these expectations do not seem relevant for somatic symptoms or functional somatic syndromes in later adulthood.