Association between depression severity and cardiac autonomic modulation

Tolentino, Júlio César; Schmidt, Sergio L.

doi:10.1016/j.jpsychores.2016.03.125

Cited by 10 publications

(18 citation statements)

References 23 publications

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“…Depression has been closely associated with autonomic nervous system dysfunction, with reduced parasympathetic and/or increased sympathetic activity leading to increased cardiovascular risk in depressed patients ( 32 – 34 ). In line with these findings, increased inter-lead QT interval differences on 12-lead electrocardiography (QT dispersion) or reduced heart rate variability (HRV) has been reported in depressed patients ( 19 , 35 – 41 ). Either reduced HRV or augmented QT dispersion reflects excessive sympathetic modulation and/or inadequate cardiac vagal control ( 19 , 35 – 44 ).…”

Section: Discussionsupporting

confidence: 56%

“…Almas et al ( 18 ) reported that moderately depressed persons showed a higher risk for cardiovascular disease (CVD) compared to severely depressed patients. Recently, Tolentino and Schmidt ( 19 ) have shown that cardiac autonomic regulation is associated with depression severity, as measured by the HAMD, in an intriguing way: moderately depressed patients showed greater impairment in autonomic modulation as compared to either severely depressed patients or non-depressed subjects. Then, subjects with moderate depression who do not seek treatment are at higher risk of CVD.…”

Section: Introductionmentioning

confidence: 99%

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DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

2018

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Background: Depression diagnosis requires five or more symptoms (Diagnostic and Statistical Manual of Mental Disorders-DSM-5). One of them must be either Depressed mood or Anhedonia, named main criteria. Although the secondary symptoms can be divided into somatic and non-somatic clusters, the DSM-5 identify depression in all or none fashion. In contrast, depression severity is a continuous variable. Therefore, it is commonly assessed with scales such as the Hamilton Depression Rating Scale (HAMD). Previously, we reported that patients with moderate depression (MD) exhibit greater impairments in cardiac-autonomic modulation than severely depressed (SD) patients. However, clinicians usually do not use scales.Objective: To verify whether the DSM-5 symptoms would be able to discriminate SD from MD and MD from non-depressed (ND) subjects.Material and Methods: Depression was diagnosed based on the Structured Clinical Interview for DSM-5® Disorders. The HAMD evaluated depression severity. In depressed subjects, MD and SD were defined considering the HAMD scores. ND was defined considering both the absence of DSM-5 criteria for depression and the HAMD score. Among 782 outpatients, 46 SD were found. MD and ND subjects were randomly sampled to match the demographic variables of the SD group.Results: Discriminant analysis showed that Depressed Mood was the most reliable symptom to discriminate ND from MD. Anhedonia discriminated SD from MD. Among the secondary DSM-5 criteria, the somatic cluster discriminated ND from MD and the non-somatic cluster SD from MD patients.Discussion: The presence of the somatic cluster in MD may indicate decreased vagal tone and/or increased sympathetic tone, leading to higher cardiovascular risk. As SD is associated with the non-somatic cluster, these patients are at risk of committing suicide. The DSM-5 symptoms exhibited by the patient may help the choice of adequate pharmacological treatment. This would avoid the use of antidepressants that unnecessarily increase cardiac risk in MD. When the symptom cluster suggests SD, the treatment must focus on the prevention of suicide.Conclusions: Depression severity may be inferred based on the DSM-5 criteria. The presence of the Anhedonia main criterium accompanied by non-somatic criteria indicate SD. The Depressive Mood criterium followed by somatic criteria suggest MD.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

2018

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“…A cross-sectional study that involved 3.148 individuals of a rural population in India has shown that men engaged in regular prayer had a significantly lower prevalence of coronary heart disease after adjustment for coronary risk factors. The education and prayer habit was considered protective for the disease of coronary arteries [6]. Burazeri et al conducted a case-control study with Muslim and Christian people, and there was included 467 nonfatal consecutive acute coronary syndrome patients.…”

Section: Review Of Literaturementioning

confidence: 99%

“…The understanding regarding the impact of psychosocial risk factor in heart disease has grown in the last decade [3][4][5]. Psychosocial stressors such as depression and chronic stress can lead dysregulation of autonomic nervous system function, endothelial dysfunction, and persistent hypothalamic pituitary adrenal axis activation in patients with cardiovascular disease or even previously cardiac healthy individuals [6][7][8][9]. In these people, behavioral factors and involvement in health promotion activities have also been implicated among the mechanisms responsible for the higher rate of cardiovascular mortality [10,11].…”

Section: Introductionmentioning

confidence: 99%

Cardiac autonomic modulation related to prayer may contribute to the reduced cardiovascular mortality associated with religiosity/spirituality

Tolentino¹,

Bedirian²

2019

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Cardiovascular disease is the leading cause of morbidity and mortality worldwide. During the past few decades, several studies have demonstrated an association between religiosity/spirituality and beneficial effects on mental and physical health. Longitudinal studies have found significant association between regular attendance at religious services and reduced all-cause and cardiovascular mortality. Among the several potential pathways of higher religiosity/spirituality, there are biological mechanisms such as decrease the inflammatory cytokines and cortisol levels, enhance of parasympathetic activation and attenuation of sympathetic nervous system activity. Prayer can be a possible mediator of the positive religiosity/spirituality effects in the cardiovascular system. The objective of this article is to review the potential mechanisms by which prayer interferes in the cardiovascular system, and which would explain its influences in cardiac mortality and morbidity. We found that prayer was associated with a lower prevalence of coronary artery disease. Studies have demonstrated that prayer was associated with a parasympathetic activity increase and decrease in the sympathetic nervous system component. In conclusion, prayer had been linked to higher levels of cardiac autonomic, a condition that is associated with a reduced risk of cardiac arrhythmias, and cardiac mortality. Scientific research on the health benefits of prayer should be expanded, aiming to obtain a clearer understanding of the possible positive action of prayer on the cardiovascular system, especially in the cardiac autonomic modulation. Although there is no recommendation of prayer prescription by cardiologists, the pivotal effects of this spiritual practice should be known within the cardiology.

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“…On the other hand, autonomic cardiac modulation manipulates human body both physiologically and psychologically, e.g., circulation in brain. Earlier work has shown that autonomic cardiac modulation has a strong relationship with human emotion state [2], the motor function of human body [3], sleep [4], etc.…”

Section: Introductionmentioning

confidence: 99%