Altered cardiac autonomic nervous function in depression

Abstract

BackgroundDepression is an independent risk factor for coronary artery disease. Autonomic instability may play a mediating or moderating role in this relationship; however this is not well understood. The objective of this study was to explore cardiac autonomic function and cardiac arrhythmia in depression, the correlation between depression severity and Heart Rate Variability (HRV) related indices, and the prevalence of arrhythmia.MethodsIndividuals (n = 53) with major depression as assessed by the Diagnostic and Statistical Manual of Mental Disorders, who had a Hamilton Rating Scale for Depression (HAMD) score ≥20 and a Zung Self-Rating Depression Scale score > 53 were compared to 53 healthy individuals, matched for age and gender. Multichannel Electrocardiograph ECG-92C data were collected over 24 hours. Long-term changes in HRV were used to assess the following vagally mediated changes in autonomic tone, expressed as time domain indices: Standard deviation of the NN intervals (SDNN), standard deviation of 5 min averaged NN intervals (SDANN), Root Mean Square of the Successive Differences (RMSSD) and percentage of NN intervals > 50 ms different from preceding interval (pNN50). Pearson’s correlations were conducted to explore the strength of the association between depression severity (using the SDS and HRV related indices, specifically SDNN and low frequency domain / high frequency domain (LF/HF)).ResultsThe values of SDNN, SDANN, RMSSD, PNN50 and HF were lower in the depression group compared to the control group (P<.05). The mean value of the LF in the depression group was higher than the in control group (P<.05). Furthermore the ratio of LF/HF was higher among the depression group than the control group (P<.05). A linear relationship was shown to exist between the severity of the depression and HRV indices. In the depression group, the prevalence of arrhythmia was significantly higher than in the control group (P<.05), particularly supraventricular arrhythmias.ConclusionsOur findings suggest that depression is accompanied by dysfunction of the cardiac autonomic nervous system, and further, that depression severity is linked to severity of this dysfunction. Individuals with depression appear to be susceptible to premature atrial and/or ventricular disease.

Acute coronary syndrome and depression: A review of shared pathophysiological pathways

“…Since that report, evidence has accumulated supporting a connection between low HRV and cardiovascular morbidity and mortality (Hillebrand et al, 2013;Stapelberg et al, 2012;Taylor, 2010;Thayer and Lane, 2007). Low HRV has also been recognised as an important covariate of major depressive disorder (Kemp et al, 2012;Wang et al, 2013) and is hypothesised to underlie the link between depression and cardiovascular events (Huikuri and Stein, 2012;Stapelberg et al, 2012;Taylor, 2010). diabetes, smoking, high cholesterol, insufficient exercise) are linked to low HRV.…”

Comparison of Heart Rate Variability Between Patients With Major Depressive Disorder and Normal Subjects

“…However, the effects of sympathetic and parasympathetic activities on the interaction between stress and depression of the autonomic nervous system remains were unclear [15]. HRV is an electrocardiograph-based technique developed to assess the relative influences of sympathetic and vagal branches over heart's beat-tobeat activity [16]. However, many factors that influence on depression have been associated with the decreased cardiac vagal control.…”

Identification of Mental Disorders by Hidden Markov Modeling of Photoplethysmograms

“…Previous epidemiological studies [6], [7], [8] have shown highly related connections between psychiatric and cardiac disorders which suggests the potentiality of using cardiac indicators as supplementary tools in psychological condition evaluation. Studies on HRV in mental diseased patients have provided evidences for the possible connection between autonomic nerves system and mental disorders [12], [14], [15], [16]. However, there are some limitations using HRV analysis.…”

“…Increased mortality of cardiac disorders raises attention to the links between autonomic dysfunction and psychiatric disorders. A body of research implicates a relative reduction in cardiac vagal tone, and reduced heart rate variability (HRV) in psychiatric disorder [12], [13], [14], [15], [16]. Photoplethysmography (PPG), signal reflecting the arterial blood pressure variability, has shown to be a simple noninvasive tool for cardiac autonomic nervous system assessment.…”