State-related differences in heart rate variability in bipolar disorder

Abstract

Heart rate variability (HRV) is a validated measure of sympato-vagal balance in the autonomic nervous system. HRV appears decreased in patients with bipolar disorder (BD) compared with healthy individuals, but the extent of state-related alterations has been sparingly investigated. The present study examined differences in HRV between affective states in BD. A heart rate and movement sensor weighing 8 g collected average acceleration, heart rate and the two slowest and fastest heart beats (of the most recent 16 beats) every 30 s over a period of at least three consecutive weekdays and nights in a prospective longitudinal design from a total of 31 different affective states in 16 outpatients with BD. A proxy measure of HRV was calculated as the difference between the second-shortest and the second-longest inter-beat-interval collected during each of the epochs. Analyses were based on over 100.000 HRV data-points. In unadjusted analyses and in analyses adjusted for age, gender and heart rate, during a manic state HRV was increased by 18% compared with a depressed state (e = 1.18, 95% CI: 1.16-1.20, p < 0.001) and increased by 17% compared with a euthymic state (e = 1.17, 95% CI: 1.15-1.19, p < 0.001), whereas there was no difference between a depressive state and a euthymic state (e = 0.98, 95% CI: 0.96-1.00, p = 0.12). Further inclusion of BMI as a covariate did not alter any of the associations. HRV appears to be altered in a state-dependent manner in bipolar disorder and could represent a candidate state marker. Further studies with larger sample sizes are warranted.

Diminution of Heart Rate Variability in Bipolar Depression

“…Decreased HRV has been reported in bipolar patients during the manic phase in some studies ( 37 , 38 ). However, these findings were not confirmed in a more recent study ( 24 , 25 ) in which the investigators found increased HRV during manic states compared with depressive and euthymic states using a longitudinal study design with repeated measurements. Additionally, these authors reported an inverse relationship between HRV and the severity of depressive symptoms and a positive association between HRV and the severity of manic symptoms.…”

“…In one particular study, both BD and recurrent MDD patients were found to have significantly lower HRV parameters than healthy controls (HCs), despite clinical remission in both groups ( 23 ). In BD patients, HRV during a manic episode is significantly higher than HRV during a depressive episode or a euthymic state ( 24 , 25 ). In the present study, we addressed three specific aims.…”

The moderating influence of heart rate variability on stressor-elicited change in pupillary and attentional indices of emotional processing: An eye-Tracking study

“…Further, Sanders and Abaied (2015) found a significant relationship between low HRV and greater anhedonic depression, but not anxious arousal symptoms. Interestingly, in two recent studies high HRV demonstrated specific associations with manic symptoms, suggesting that HRV may generally index disturbances in positive valence and reward processing neural systems (Faurholt-Jepsen, Brage, Kessing, & Munkholm, 2017; Gruber, Mennin, Fields, Purcell, & Murray, 2015). Given that anhedonia symptoms have been proposed to arise from dysfunctional interactions between stress and reward neural systems (Pizzagalli, 2014), low HRV may specifically predict anhedonia via altered processing of positive emotional information during acute stress.…”

Heart rate variability in patients with bipolar disorder: From mania to euthymia

“…A recent study found a positive association between HRV and severity manic symptoms (Faurholt-Jepsen et al, 2017b). However, the patients in that study received different types, doses and combinations of medication during the study and the data were collected and analyzed from only seven patients during manic/mixed state.…”