Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-14T17:08:24.470Z Has data issue: false hasContentIssue false
  • English
  • Français

Major depression is associated with cardiac autonomic dysregulation

Published online by Cambridge University Press:  24 June 2014

Hsin-An Chang ,
Chuan-Chia Chang ,
Chih-Lun Chen ,
Terry B. J. Kuo ,
Ru-Band Lu  and
San-Yuan Huang
Hsin-An Chang
Affiliation:
Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
Chuan-Chia Chang
Affiliation:
Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
Chih-Lun Chen
Affiliation:
Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
Terry B. J. Kuo
Affiliation:
Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
Ru-Band Lu
Affiliation:
Institute of Behavioral Medicine and Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
San-Yuan Huang*
Affiliation:
Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

cardiac autonomic functioncardiac vagal controlheart rate variabilitymajor depression
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 24 , Issue 6 , December 2012 , pp. 318 - 327
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Murray, CJ, Lopez, AD.Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet 1997;349:1498–1504.CrossRefGoogle ScholarPubMed
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;27:2763–2764.CrossRefGoogle Scholar
3.Thayer, JF, Lane, RD.The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psych 2007; 74:224–242.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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;93:1043–1065.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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:H2233–H2239.Google ScholarPubMed
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;100:137–141.CrossRefGoogle ScholarPubMed
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;113:139–149.CrossRefGoogle ScholarPubMed
10.Rottenberg, J.Cardiac vagal control in depression: a critical analysis. Biol Psychol 2007;74:200–211.Google Scholar
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;62:187–198.CrossRefGoogle ScholarPubMed
12.Lehofer, M, Moser, M, Hoehn-Saric, R et al. Major depression and cardiac autonomic control. Biol Psychiatry 1997;42:914–919.Google Scholar
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;76:23–30.CrossRefGoogle ScholarPubMed
14.Thayer, JF, Smith, M, Rossy, LA, Sollers, JJ, Friedman, BH.Heart period variability and depressive symptoms: gender differences. Biol Psychiatry 1998;44:304–306.CrossRefGoogle ScholarPubMed
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;65:1358–1367.CrossRefGoogle ScholarPubMed
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;67:1067–1074.CrossRefGoogle ScholarPubMed
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;71:265–272.Google Scholar
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;13:183–214.Google Scholar
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;60:507–514.CrossRefGoogle ScholarPubMed
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;26:1033–1039.CrossRefGoogle ScholarPubMed
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;32:121–128.Google Scholar
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;19:344–350.Google Scholar
23.Endicott, J, Spitzer, RL.A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 1978;35:837–844.CrossRefGoogle ScholarPubMed
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;96:56–60.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
25.Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J.An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.CrossRefGoogle ScholarPubMed
26.The Whoqol Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998;28:551–558.Google Scholar
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: 342–351.Google ScholarPubMed
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:H2233–H2239.Google Scholar
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;95:1441–1448.Google Scholar
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;73:212–217.Google Scholar
31.Martin, LA, Doster, JA, Critelli, JW et al. Ethnicity and type D personality as predictors of heart rate variability. Int J Psychophysiol 2010;76:1118–1121.Google Scholar
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;77:701–705.CrossRefGoogle ScholarPubMed
33.Carney, RM, Rich, MW, Tevelde, A et al. Major depressive disorder in coronary artery disease. Am J Cardiol 1987;60:1273–1275.CrossRefGoogle ScholarPubMed
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;48:115–124.Google Scholar
35.Yeragani, VK, Pohl, R, Balon, R et al. Heart rate variability in patients with major depression. Psychiatry Res 1991;37:35–46.CrossRefGoogle ScholarPubMed
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:H674–H679.Google Scholar
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;4:1523–1529.CrossRefGoogle Scholar
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;37:185–194.Google Scholar
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;93:263–272.Google Scholar
40.Hansen, AL, Johnsen, BH, Thayer, JE.Vagal influence on working memory and attention. Int J Psychophysiol 2003;48:263–274.CrossRefGoogle ScholarPubMed
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;17:1105–1127.CrossRefGoogle ScholarPubMed
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;69:735–739.Google Scholar
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;154:99–105.Google Scholar
44.Post, RM.Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry 1992;149:999–1010.Google ScholarPubMed
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;104:231–236.CrossRefGoogle ScholarPubMed
46.Carney, RM, Blumenthal, JA, Stein, PK et al. Depression, heart rate variability, and acute myocardial infarction. Circulation 2001;104:2024–2028.CrossRefGoogle ScholarPubMed
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;156:759e1–759e7.Google Scholar