Major depression is associated with cardiac autonomic dysregulation

Abstract

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. Significant outcomes• Patients with MD exhibited reduced cardiac vagal control compared to healthy volunteers. • Depression severity was inversely correlated with cardiac vagal control. • The subgroup of MD with suicide ideation revealed more pronounced cardiac vagal withdrawal. Limitations• Causality cannot be inferred from our cross-sectional data.• We fail to use non-linear techniques, which may be more sensitive to depression than linear techniques, to measure HRV. • Interpretation of LF as sympathetic activity should be made with caution in our study.

Motivational systems and autonomic functioning: Overlapping and differential contributions to anhedonic depression and anxious arousal

“…Our findings add to previous work suggesting that low RSA contributes to emotion dysregulation and may place an individual at risk for depressive symptoms (Chang et al 2012;Udupa et al 2007). One possible explanation for the nonsignificant link between RSA and anxious arousal may lie in our control variable of anhedonic depressive symptoms; many previous studies have not adjusted for anxiety symptoms, and individuals with comorbid anxiety and depressive symptoms exhibit lower RSA than those only displaying symptoms of anxiety (Hofmann et al 2010).…”

“…Individuals with low RSA are thought to be more prone to dysregulated emotional responses and response patterns that contribute to the development of a variety of forms of psychopathology (Porges 2007(Porges , 1994. Low RSA is associated with higher levels of symptoms of both anxiety (i.e., worry and panic; Brosschot et al 2007;Friedman and Thayer 1998) and depression (Chang et al 2012;Dietrich et al 2007; see Rottenberg 2007 for a review). In this way, RSA may help to explain the overlap between depressive and anxious symptoms.…”

Bright light therapy for depression: A review of its effects on chronobiology and the autonomic nervous system

“…A few studies in drug-naïve depressed individuals have found a significantly higher sympathovagal tone among depressed patients relative to demographically matched healthy controls (Berger et al, 2012; Chang et al, 2012; Udupa et al, 2007). Such autonomic allostasis appears to be more pronounced in subjects with current or historical suicidal ideation (Chang et al, 2012) and preferentially expressed in cardiac indices of autonomic function rather than in respiratory indices (Berger et al, 2012).…”

“…Such autonomic allostasis appears to be more pronounced in subjects with current or historical suicidal ideation (Chang et al, 2012) and preferentially expressed in cardiac indices of autonomic function rather than in respiratory indices (Berger et al, 2012). A select few other trials have investigated the link between MDD and ANS activity in drug-naïve subjects: one using cognitive-behavioral therapy (Carney et al, 2000) and two using acupuncture (Chambers & Allen, 2002; Rottenberg et al, 2007).…”

Reduced QT Variability and increased QT/RR slope in ECG signals of Depressed Patients with Suicidal Ideation

“…Fifteen percent of clinically depressed patients die by suicide [7]. Patients with suicidal tendencies exhibited significant and more pronounced cardiac vagal withdrawal compared to healthy counterparts, as well as MDD patients without suicidal ideation [8].…”