Nighttime heart rate predicts response to depression treatment in patients with coronary heart disease

Abstract

Background Previous studies suggest that patients with coronary heart disease (CHD) who do not respond to treatment for depression are at higher risk of mortality than are treatment responders. The purpose of this study was to determine whether elevated nighttime heart rate (HR) and low heart rate variability (HRV), both of which have been associated with depression and with cardiac events in patients with CHD, predict poor response to depression treatment in patients with CHD. Methods Patients with stable CHD and a current major depressive episode completed 24 hour ambulatory ECG monitoring and were then treated for up to 16 weeks with cognitive behavior therapy (CBT), either alone or in combination with an antidepressant. Pre-treatment HR and HRV were calculated for 124 patients who had continuous ECG from early evening to mid-morning. Results Following treatment, 64 of the 124 patients (52%) met study criteria for remission (Hamilton Rating Scale for Depression score < 7). Prior to treatment, non-remitters had higher nighttime HR (p=0.03) and lower nighttime HRV (p=0.01) than did the remitters, even after adjusting for potential confounds. Limitations Polysomnography would have provided information about objective sleep characteristics and sleep disorders. More CBT sessions and higher doses of antidepressants may have resulted in more participants in remission. Conclusions High nighttime HR and low nighttime HRV predict a poor response to treatment of major depression in patients with stable CHD. These findings may help explain why patients with CHD who do not respond to treatment are at higher risk for mortality.

Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study

“…We found an association between greater heart rate variability and a favourable depression outcome, which is in line with previous findings where heart rate variability is discussed as a marker of emotional dysregulation and predicts an increased disease risk [53–55]. One study could show that a low (nighttime) heart rate variability was a significant predictor of a poor response to treatment of major depression in patients with stable CAD [56]. Caldwell et al (2018) suggest the use of a heart rate variability biofeedback in combination with psychotherapy, improving the outcome of depression treatment [53].…”

Entropy-Based Measures of Hypnopompic Heart Rate Variability Contribute to the Automatic Prediction of Cardiovascular Events

“…Moreover, by using nonlinear techniques to automatically classify the HRV signals of healthy people and those at risk of sudden cardiac death (SCD), Fujita [ 61 ] demonstrated that HRV was able to identify the person at four minutes prior to SCD. Carney [ 62 ] recently showed that high heart rate and low HRV during nighttime could be used as a predictor of the poor response to the treatment of major depression and of the higher risk for mortality in patients with stable coronary heart disease. This study further clarifies the association between sleep HRV and CVD, and establishes the role of hypnopompic HRV in the automatic prediction of short-term CVD events.…”

Impact of Depression and Psychosocial Treatment on Heart Rate Variability in Patients with Type 2 Diabetes Mellitus: An Exploratory Analysis Based on the HEIDIS Trial

“…Another reason for not detecting possible effects could be that our methods for assessing depressive symptoms or heart rate variability were not valid enough and therefore could not detect existing differences. Other studies have used clinical diagnostic interviews to assess depression [38,39]; however, for example Francis et al used questionnaires to assess depression and could identify the postulated associations [40]. The PHQ-9, which we used in our study, has the advantage that it can simultaneously be used as a diagnostic algorithm to make a probable diagnosis of major depressive disorder or as a continuous measure of depressive symptoms and is equal or superior to similar instruments [41].…”