Skip to main content Accessibility help
×
Home

Major depression is associated with cardiac autonomic dysregulation

  • 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)...

Extract

Chang H-A, Chang C-C, Chen C-L, Kuo TBJ, Lu R-B, Huang S-Y. Major depression is associated with cardiac autonomic dysregulation.

Objective: Altered cardiac autonomic function has been proposed in patients with major depression (MD), but the results are mixed. Therefore, analyses with larger sample sizes and better methodology are needed.

Methods: To examine whether cardiac autonomic dysfunction is associated with MD, 498 unmedicated patients with MD and 462 healthy volunteers, aged 18–65 years, were recruited for a case-control analysis. We used the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory (BDI) to assess depression severity. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV) parameters. Frequency-domain indices of HRV were obtained.

Results: Patients with MD exhibited reduced cardiac vagal control compared to healthy volunteers, and depression severity was negatively correlated with cardiac vagal control. Stratified analyses by suicide ideation revealed more pronounced cardiac vagal withdrawal among MD patients with suicide ideation.

Conclusion: This study shows that MD is associated with cardiac autonomic dysregulation, highlighting the importance of assessing HRV in currently depressed patients, given the higher risk for cardiac complications in these individuals. Taking into account that suicidal depressed patients had more adverse patterns of HRV, one might consider the treatment to restore the autonomic function for the patient population having increased susceptibility to autonomic dysregulation.

Copyright

Corresponding author

San-Yuan Huang, Professor and Attending Psychiatrist, Department of Psychiatry, Tri-Service General Hospital, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei 114, Taiwan. Tel: 011-886-2-8792-7220; Fax: 011-886-2-8792-7221; E-mail: chang.ha@msa.hinet.net

References

Hide All
1.Murray, CJ, Lopez, AD.Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet 1997;349:14981504.
2.Nicholson, 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;27:27632764.
3.Thayer, JF, Lane, RD.The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psych 2007; 74:224242.
4.Huikuri, H, Raatikainen, M, Moerch-Joergensen, R et al. Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction. Eur Heart J 2009;30:689.
5.Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93:10431065.
6.van Zyl, LT, Hasegawa, T, Nagata, K.Effects of antidepressant treatment on heart rate variability in major depression: a quantitative review. Biopsychosoc Med 2008;2:12.
7.Kuo, TBJ, Lin, T, Yang, CCH, Li, CL, Chen, CF, Chou, P.Effect of aging on gender differences in neural control of heart rate. Am J Physiol 1999;277:H2233H2239.
8.Udupa, K, Sathyaprabha, TN, Thirthalli, J et al. Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures. J Affect Disord 2007;100:137141.
9.Agelink, 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.
10.Rottenberg, J.Cardiac vagal control in depression: a critical analysis. Biol Psychol 2007;74:200211.
11.Agelink, MW, Majewski, T, Wurthmann, C et al. Autonomic neurocardiac function in patients with major depression and effects of antidepressive treatment with nefazodone. J Affect Disord 2001;62:187198.
12.Lehofer, M, Moser, M, Hoehn-Saric, R et al. Major depression and cardiac autonomic control. Biol Psychiatry 1997;42:914919.
13.Volkers, 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.
14.Thayer, JF, Smith, M, Rossy, LA, Sollers, JJ, Friedman, BH.Heart period variability and depressive symptoms: gender differences. Biol Psychiatry 1998;44:304306.
15.Licht, CMM, de Geus, EJC, Zitman, FG, Hoogendijk, WJG, van Dyck, R, Penninx, BWJH.Association between major depressive disorder and heart rate variability in the Netherlands study of depression and anxiety (NESDA). Arch Gen Psychiatry 2008;65:13581367.
16.Kemp, 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 2010;67:10671074.
17.Rottenberg, J, Wilhelm, FH, Gross, JJ, Gotlib, IH.Respiratory sinus arrhythmia as a predictor of outcome in major depressive disorder. J Affect Disord 2002;71:265272.
18.Beauchaine, TP.Vagal tone, development, and Gray's motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology. Dev Psychopathol 2001;13:183214.
19.Booij, 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.
20.Yen, CF, Chen, CC, Lee, Y, Tang, TC, Ko, CH, Yen, JY.Association between quality of life and self-stigma, insight, and adverse effects of medication in patients with depressive disorders. Depress Anxiety 2009;26:10331039.
21.Chang, CC, Lu, RB, Chen, CL et al. Lack of association between the norepinephrine transporter gene and major depression in Han Chinese population. J Psychiatry Neurosci 2007;32:121128.
22.Chang, HA, Lu, RB, Lin, WW et al. Lack of association between dopamine D3 receptor Ser9Gly polymorphism and schizophrenia in Han Chinese. Acta Neuropsychiatrica 2007;19:344350.
23.Endicott, J, Spitzer, RL.A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 1978;35:837844.
24.Du, 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.
25.Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J.An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561571.
26.The Whoqol Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998;28:551558.
27.Yao, G, Chung, CW, Yu, CF, Wang, JD.Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. J Formosan Med Assoc 2002;101: 342351.
28.Kuo, TB, Lin, T, Yang, CCLi, CL, Chen, CF, Chou, P.Effect of aging on gender differences in neural control of heart rate. Am J Physiol 1999;277:H2233H2239.
29.Pagani, M, Montano, N, Porta, A et al. Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation 1997;95:14411448.
30.Li, Z, Snieder, H, Su, S et al. A longitudinal study in youth of heart rate variability at rest and in response to stress. Int J Psychophysiol 2009;73:212217.
31.Martin, LA, Doster, JA, Critelli, JW et al. Ethnicity and type D personality as predictors of heart rate variability. Int J Psychophysiol 2010;76:11181121.
32.Stein, PK, Rottman, JN, Kleiger, RE.Effect of 21 mg transdermal nicotine patches and smoking cessation on heart rate variability. Am J Cardiol 1996;77:701705.
33.Carney, RM, Rich, MW, Tevelde, A et al. Major depressive disorder in coronary artery disease. Am J Cardiol 1987;60:12731275.
34.Moser, M, Lehofer, M, Hoehn-Saric, R et al. Increased heart rate in depressed subjects in spite of unchanged autonomic balance? J Affect Disord 1998;48:115124.
35.Yeragani, VK, Pohl, R, Balon, R et al. Heart rate variability in patients with major depression. Psychiatry Res 1991;37:3546.
36.Baumert, M, Lambert, GW, Dawood, T et al. Short-term heart rate variability and cardiac norepinephrine spillover in patients with depression and panic disorder. Am J Physiol Heart Circ Physiol 2009;297:H674H679.
37.Moak, JP, Goldstein, DS, Eldadah, BA et al. Supine low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Heart Rhythm 2007;4:15231529.
38.Allen, 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.
39.Hansen, AL, Johnsen, BH, Sollers, JJ IIIStenvik, K, Thayer, JF.Heart rate variability and its relation to prefrontal cognitive function: the effects of training and detraining. Eur J Appl Physiol 2004;93:263272.
40.Hansen, AL, Johnsen, BH, Thayer, JE.Vagal influence on working memory and attention. Int J Psychophysiol 2003;48:263274.
41.Crowell, 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.
42.de Jonge, P, Mangano, D, Whooley, MA.Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosom Med 2007;69:735739.
43.Atkinson, M, Zibin, S, Chuang, H.Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology. Am J Psychiatry 1996;154:99105.
44.Post, RM.Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry 1992;149:9991010.
45.Udupa, 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.
46.Carney, RM, Blumenthal, JA, Stein, PK et al. Depression, heart rate variability, and acute myocardial infarction. Circulation 2001;104:20242028.
47.Lampert, R, Bremner, JD, Su, S et al. Decreased heart rate variability is associated with higher levels of inflammation in middle-aged men. Am Heart J 2008;156:759e1759e7.

Keywords

Major depression is associated with cardiac autonomic dysregulation

  • 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)...

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