Cardiovascular Variability and Reactivity in Major Depressive Disorder

Abstract

Abstract. This study investigated cardiovascular variability and stress reactivity in major depressive disorder (MDD). While previous research has documented reduced heart rate variability, knowledge about blood pressure variability in MDD remains scarce. Regarding reactivity, a particular focus was placed on the time courses of the cardiovascular responses, which may provide insight into the autonomic mechanisms underlying the hypo-reactivity expected in MDD. In 76 MDD patients and 71 healthy controls, blood pressure was continuously recorded at rest and during mental stress induced by a 3-min serial subtraction task. Compared to controls, patients exhibited lower systolic and diastolic blood pressure, heart rate variability, and systolic and diastolic blood pressure variability. Moreover, smaller stress-related changes in heart rate, systolic and diastolic blood pressure, and sensitivity of the cardiac baroreflex arose in patients. Cardiovascular parameters did not differ between patients using antidepressants and unmedicated patients. According to time-course analysis, reduced hemodynamic modulations in MDD mainly occurred after 50 s of the stress period. Low heart rate variability in MDD reflects deficient top-down integration of the brain mechanisms allowing flexible autonomic and behavioral control; diminished blood pressure variability is indicative of poor homeostatic capacity with respect to the regulation of blood pressure and organ perfusion. Moreover, blunted cardiovascular reactivity implies poor adjustment of energetic resources to internal and environmental demands and may be a correlate of deficient motivational dynamics characterizing MDD. While cardiovascular hypo-reactivity in MDD may be mediated by baroreflex and adrenergic mechanisms, the fast-acting parasympathetic system may play a subordinate role.

Early Life Adversity and Blunted Cardiovascular Reactivity to Acute Psychological Stress: The Role of Current Depressive Symptoms

“…Psychosomatic Medicine, V 84 • 170-178 (69). Although no significant interaction was observed for HR, associations were observed in our regression models.…”

Exhausted Heart Rate Responses to Repeated Psychological Stress in Women With Major Depressive Disorder

“…Results showed marked elevations in HR, lower vagally mediated HRV at rest and insufficient subjective stress recovery in women with depression. The results confirm previous findings showing blunted cardiac vagal modulation during stress in patients with MDD, e.g., Schiweck et al ( 18 ) and Duschek et al ( 63 ). In addition, we extend the literature by showing that repeated stress exposure provoked strongly reduced HR responses and poor subjective recovery in patients with depression, as opposed to healthy controls.…”

The cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia: Associations with pain, affective impairments, sleep problems, and fatigue

“…Lower variability in IBI (i.e., HRV) and TPR, as well as marginally lower variability in PEP, was seen in FMS patients than healthy participants. Variability in physiological variables has been interpreted as a marker of health, intact top-down integration of brain mechanisms, optimal homeostatic regulation functioning, and the flexibility necessary to respond to internal and external demands and perturbations (Duschek et al, 2021;Montoro, Duschek, Schuepbach, et al, 2018). As such, the reduction in cardiovascular variability supports the notion of deficient autonomic flexibility and adaptability, as well as deficiencies in baroreflex functioning, in FMS.…”

“…To evaluate the validity of the derived indices of baroreflex function, associations between BRS in each branch and the corresponding reflex output variables were quantified. Variability in physiological variables is regarded as a marker of health and optimal homeostatic regulation (Duschek et al, 2021;Montoro, Duschek, Schuepbach, et al, 2018). Given that short-term variability in cardiovascular variables is under baroreflex control (Reyes del Paso et al, 2017), alterations in BRS and BEI should be associated with reduced cardiovascular variability.…”