<p>Cardiac dysautonomia in depression – heart rate variability biofeedback as a potential add-on therapy</p>

Abstract

Depressive disorders are among the most important health problems and are predicted to constitute the leading cause of disease burden by the year 2030. Aside significant impact on quality of life, psychosocial well-being and socioeconomic status of affected patients, depression is associated with impaired cardiovascular health and increased mortality. The link between affective and cardiovascular disease has largely been attributed to dysregulation of the autonomic nervous system resulting in a chronic shift toward increased sympathetic and decreased parasympathetic activity and, consecutively, cardiac dysautonomia. Among proposed surrogate parameters to capture and quantitatively analyze this shift, heart rate variability (HRV) and baroreflex sensitivity have emerged as reliable tools. Attenuation of these parameters is frequently seen in patients suffering from depression and is closely linked to cardiovascular morbidity and mortality. Therefore, diagnostic and therapeutic strategies were designed to assess and counteract cardiac dysautonomia. While psychopharmacological treatment can effectively improve affective symptoms of depression, its effect on cardiac dysautonomia is limited. HRV biofeedback is a non-invasive technique which is based on a metronomic breathing technique to increase parasympathetic tone. While some small studies observed beneficial effects of HRV biofeedback on dysautonomia in patients with depressive disorders, larger confirmatory trials are lacking. We reviewed the current literature on cardiac dysautonomia in patients suffering from depression with a focus on the underlying pathophysiology as well as diagnostic workup and treatment.

Feature of Heart Rate Variability and Metabolic Mechanism in Female College Students with Depression

“…Some research reported that HF and LF were significantly reduced in patients with chronic fatigue syndrome (CFS) or anxiety, which discovered there were an imbalance of cardiac autonomic nerves and the decreased cardiac vagus function in some mental illness [33,34]. Moreover, a recent study reported the average heart rate was increased in patients with depression [35]. In the present study, our results demonstrated that both the HF and LF of the subjects with depression were significantly reduced, and the average heart rate was significantly increased, confirming that depression could also cause an imbalance of cardiac autonomic nerves and the decreased cardiac vagus function in college students.…”

Autonomic Dysfunction in Preeclampsia: A Systematic Review

“…Dysautonomia in PE may be alleviated by an easy-to-learn technique, the heart rate variability biofeedback. It has been shown to improve both autonomic functioning and perinatal anxiety and depression (75, 76).…”

The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review

“…Higher HRV is observed in those who are more persistent in solving complex problems while intensive selfcontrol efforts are required [54]. A shift from parasympathetic to sympathetic autonomic activity resulting in cardiac dysautonomia is frequently found in depression [55]. Karavidas [56] stated that depression is associated with a decreased HRV.…”