Skip to main content Accessibility help
×
Home

Heart rate variability in patients with fully remitted major depressive disorder

  • Hsin-An Chang (a1), Chuan-Chia Chang (a1), Chih-Lun Chen (a1), Terry B. J. Kuo (a2), Ru-Band Lu (a3) and San-Yuan Huang (a1)...

Abstract

Objective

Cardiac autonomic dysregulation has been reported in major depressive disorder (MDD), but scarce studies investigated that in fully remitted MDD.

Methods

To examine cardiac autonomic function in remitted MDD, 470 unmedicated individuals with a diagnosis of MDD earlier in life and 462 healthy volunteers, aged 18–65 years, were recruited for a case–control analysis. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV) parameters. Frequency-domain indices of HRV were obtained. The obtained results were evaluated in association with personality traits assessed by the Tridimensional Personality Questionnaire.

Results

In patients with remitted MDD, no differences in RR intervals and all frequency-domain indices of HRV could be detected as compared with controls. Stratified analyses by the presence of a history of suicide ideation (the SI+ vs. the SI-subgroup) revealed decreased cardiac vagal control in the SI+ subgroup. The correlation analysis revealed an inverse relation between HRV levels and the harm avoidance score (which has been suggested to be associated with serotonergic activity), mainly attributable to the robust association in the SI+ subgroup.

Conclusion

Our study shows that cardiac autonomic dysregulation is not shown in remitted MDD patients as a whole but is limited to the subgroup of remitted MDD patients with a history of suicidal ideation. In view of the higher risk for cardiac complications in these vulnerable individuals, one might consider the treatment to restore their autonomic function.

Copyright

Corresponding author

San-Yuan Huang, Department of Psychiatry, Tri-Service General Hospital, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, 114, Taiwan, ROC. Tel: +11-886-2-8792-7220; Fax: +11-886-2-8792-7221; E-mail: chang.ha@msa.hinet.net

References

Hide All
1Barth, J, Schumacher, M, Herrmann-Lingen, C.Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med 2004;66:802813.
2Nicholson, A, Kuper, H, Hemingway, H.Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J 2006;27:27632774.
3Thayer, JF, Lane, RD.The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psychol 2007;74:224242.
4Agelink, MW, Majewski, T, Wurthmann, Cet al.Autonomic neurocardiac function in patients with major depression and effects of antidepressive treatment with nefazodone. J Affect Disord 2001;62:187198.
5Udupa, K, Sathyaprabha, TN, Thirthalli, Jet al.Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures. J Affect Disord 2007;100:137141.
6Agelink, MW, Boz, C, Ullrich, H, Andrich, J.Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Res 2002;113:139149.
7Rechlin, T, Weis, M, Spitzer, A, Kaschka, WP.Are affective disorders associated with alterations of heart rate variability? J Affect Disord 1994;32:271275.
8Rottenberg, J.Cardiac vagal control in depression: a critical analysis. Biol Psychol 2007;74:200211.
9Lehofer, M, Moser, M, Hoehn-Saric, Ret al.Major depression and cardiac autonomic control. Biol Psychiatry 1997;42:914919.
10Dawood, T, Lambert, EA, Barton, DAet al.Specific serotonin reuptake inhibition in major depressive disorder adversely affects novel markers of cardiac risk. Hypertens Res 2007;30:285293.
11Volkers, AC, Tulen, JH, Van Den Broek, WW, Bruijn, JA, Passchier, J, Pepplinkhuizen, L.Motor activity and autonomic cardiac functioning in major depressive disorder. J Affect Disord 2003;76:2330.
12Kemp, AH, Quintana, DS, Gray, MA, Felmingham, KL, Brown, K, Gatt, JM.Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry 67:10671074.
13Licht, CM, De Geus, EJ, Zitman, FG, Hoogendijk, WJ, Van Dyck, R, Penninx, BW.Association between major depressive disorder and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA). Arch Gen Psychiatry 2008;65:13581367.
14Bar, KJ, Greiner, W, Jochum, T, Friedrich, M, Wagner, G, Sauer, H.The influence of major depression and its treatment on heart rate variability and pupillary light reflex parameters. J Affect Disord 2004;82:245252.
15Akselrod, S, Gordon, D, Ubel, FA, Shannon, DC, Berger, AC, Cohen, RJ.Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 1981;213:220222.
16Booij, L, Swenne, CA, Brosschot, JF, Haffmans, PM, Thayer, JF, Van Der Does, AJ.Tryptophan depletion affects heart rate variability and impulsivity in remitted depressed patients with a history of suicidal ideation. Biol Psychiatry 2006;60:507514.
17Chang, HA, Chang, CC, Chen, CLet al.Major depression is associated with cardiac autonomic dysregulation. Acta Neuropsychiatrica 2012 (in press).
18Chang, CC, Lu, RB, Chen, CLet al.Lack of association between the norepinephrine transporter gene and major depression in a Han Chinese population. J Psychiatry Neurosci 2007;32:121128.
19Endicott, J, Spitzer, RL.A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 1978;35:837844.
20Chang, HA, Lu, RB, Lin, WWet al.Lack of association between Dopamine D3 receptor Ser9Gly polymorphism and schizophrenia in Han Chinese. Acta Neuropsychiatrica 2007;19:344350.
21Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:5662.
22Frank, E, Prien, RF, Jarrett, RBet al.Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry 1991;48:851855.
23Kuo, TB, Lin, T, Yang, CC, Li, CL, Chen, CF, Chou, P.Effect of aging on gender differences in neural control of heart rate. Am J Physiol 1999;277:H2233H2239.
24Chen, WJ, Chen, HM, Chen, CC, Yu, WY, Cheng, AT.Cloninger's Tridimensional Personality Questionnaire: psychometric properties and construct validity in Taiwanese adults. Compr Psychiatry 2002;43:158166.
25Cloninger, CR.Neurogenetic adaptive mechanisms in alcoholism. Science 1987;236:410416.
26Liu, CC, Kuo, TB, Yang, CC.Effects of estrogen on gender-related autonomic differences in humans. Am J Physiol Heart Circ Physiol 2003;285:H2188H2193.
27Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996;93:10431065.
28Li, Z, Snieder, H, Su, Set al.A longitudinal study in youth of heart rate variability at rest and in response to stress. Int J Psychophysiol 2009;73:212217.
29Martin, LA, Doster, JA, Critelli, JWet al.Ethnicity and Type D personality as predictors of heart rate variability. Int J Psychophysiol 76:118121.
30Porges, SW.Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A Polyvagal Theory. Psychophysiology 1995;32:301318.
31Daban, C, Martinez-Aran, A, Cruz, N, Vieta, E.Safety and efficacy of Vagus Nerve Stimulation in treatment-resistant depression. A systematic review. J Affect Disord 2008;110:115.
32Pomeranz, B, Macaulay, RJ, Caudill, MAet al.Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol 1985;248:H151H153.
33Sloan, RP, Mccreath, H, Tracey, KJ, Sidney, S, Liu, K, Seeman, T.RR interval variability is inversely related to inflammatory markers: the CARDIA study. Mol Med 2007;13:178184.
34Goedhart, AD, Willemsen, G, Houtveen, JH, Boomsma, DI, Geus, DE. EJComparing low frequency heart rate variability and preejection period: two sides of a different coin. Psychophysiology 2008;45:10861090.
35Goldstein, DS, Bentho, O, Park, MY, Sharabi, Y.Low-frequency power of heart rate variability is not a measure of cardiac sympathetic tone but may be a measure of modulation of cardiac autonomic outflows by baroreflexes. Exp Physiol 96:12551261.
36Allen, MT, Matthews, KA, Kenyon, KL.The relationships of resting baroreflex sensitivity, heart rate variability and measures of impulse control in children and adolescents. Int J Psychophysiol 2000;37:185194.
37Hansen, AL, Johnsen, BH, Thayer, JF.Vagal influence on working memory and attention. Int J Psychophysiol 2003;48:263274.
38Crowell, SE, Beauchaine, TP, Mccauley, E, Smith, CJ, Stevens, AL, Sylvers, P.Psychological, autonomic, and serotonergic correlates of parasuicide among adolescent girls. Dev Psychopathol 2005;17:11051127.
39Beauchaine, T.Vagal tone, development, and Gray's motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology. Dev Psychopathol 2001;13:183214.
40Du, L, Bakish, D, Lapierre, YD, Ravindran, AV, Hrdina, PD.Association of polymorphism of serotonin 2A receptor gene with suicidal ideation in major depressive disorder. Am J Med Genet 2000;96:5660.
41Post, RM.Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry 1992;149:9991010.
42Perroud, N, Uher, R, Hauser, Jet al.History of suicide attempts among patients with depression in the GENDEP project. J Affect Disord 123:131137.
43Gensichen, J, Teising, A, Konig, J, Gerlach, FM, Petersen, JJ.Predictors of suicidal ideation in depressive primary care patients. J Affect Disord 125:124127.
44Booij, L, Van Der Does, W, Benkelfat, Cet al.Predictors of mood response to acute tryptophan depletion. A reanalysis. Neuropsychopharmacology 2002;27:852861.
45Peirson, AR, Heuchert, JW, Thomala, L, Berk, M, Plein, H, Cloninger, CR.Relationship between serotonin and the temperament and character inventory. Psychiatry Res 1999;89:2937.
46Wu, IT, Lee, IH, Yeh, TLet al.The association between the harm avoidance subscale of the Tridimensional Personality Questionnaire and serotonin transporter availability in the brainstem of male volunteers. Psychiatry Res 181:241244.
47Lesch, KP, Bengel, D, Heils, Aet al.Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science 1996;274:15271531.
48Osher, Y, Hamer, D, Benjamin, J.Association and linkage of anxiety-related traits with a functional polymorphism of the serotonin transporter gene regulatory region in Israeli sibling pairs. Mol Psychiatry 2000;5:216219.
49Kellett, DO, Ramage, AG, Jordan, D.Central 5-HT7 receptors are critical for reflex activation of cardiac vagal drive in anaesthetized rats. J Physiol 2005;563:319331.
50Kellett, DO, Stanford, SC, Machado, BH, Jordan, D, Ramage, AG.Effect of 5-HT depletion on cardiovascular vagal reflex sensitivity in awake and anesthetized rats. Brain Res 2005;1054:6172.
51Damaso, EL, Bonagamba, LG, Kellett, DO, Jordan, D, Ramage, AG, Machado, BH.Involvement of central 5-HT7 receptors in modulation of cardiovascular reflexes in awake rats. Brain Res 2007;1144:8290.
52Frederiks, J, Swenne, CA, Tenvoorde, BJet al.The importance of high-frequency paced breathing in spectral baroreflex sensitivity assessment. J Hypertens 2000;18:16351644.
53Yang, AC, Chen, TJ, Tsai, SJet al.BDNF Val66Met polymorphism alters sympathovagal balance in healthy subjects. Am J Med Genet B Neuropsychiatr Genet 153B:10241030.
54Van Praag, HM.Anxiety/aggression–driven depression. A paradigm of functionalization and verticalization of psychiatric diagnosis. Prog Neuropsychopharmacol Biol Psychiatry 2001;25:893924.
55Van Heeringen, C, Audenaert, K, Van Laere, Ket al.Prefrontal 5-HT2a receptor binding index, hopelessness and personality characteristics in attempted suicide. J Affect Disord 2003;74:149158.
56Conrad, R, Walz, F, Geiser, F, Imbierowicz, K, Liedtke, R, Wegener, I.Temperament and character personality profile in relation to suicidal ideation and suicide attempts in major depressed patients. Psychiatry Res 2009;170:212217.
57Takahashi, T, Murata, T, Hamada, Tet al.Changes in EEG and autonomic nervous activity during meditation and their association with personality traits. Int J Psychophysiol 2005;55:199207.
58Udupa, K, Sathyaprabha, TN, Thirthalli, J, Kishore, KR, Raju, TR, Gangadhar, BN.Modulation of cardiac autonomic functions in patients with major depression treated with repetitive transcranial magnetic stimulation. J Affect Disord 2007;104:231236.
59Carney, RM, Blumenthal, JA, Stein, PKet al.Depression, heart rate variability, and acute myocardial infarction. Circulation 2001;104:20242028.
60Lampert, R, Bremner, JD, Su, Set al.Decreased heart rate variability is associated with higher levels of inflammation in middle-aged men. Am Heart J 2008;156:759:e751e757.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed