Heart rate and high frequency heart rate variability during stress as biomarker for clinical depression. A systematic review

Abstract

The interaction of physical and mental vulnerability and environmental constraints is thought to foster the development of psychiatric disorders such as major depressive disorder (MDD). A central factor in the development of psychopathology is mental stress. Despite some evidence for parasympathetic withdrawal and sympathetic overactivity in MDD, the psychophysiological response to stress in depression is not clear-cut. Given the growing interest in heart rate and heart rate variability as indicators for remote monitoring of patients, it is important to understand how patients with MDD react to stress in a laboratory-controlled environment. We conducted a systematic review of studies using electrocardiography to derive heart rate and heart rate variability during stress in patients with clinical depression. We focused on well-validated stress tasks- the mental arithmetic stress task, the Trier social stress task and public speaking task- to minimize confounding effects due to the nature of the stressor. The majority of studies found hypo-reactivity during stress as a hallmark of depression as evidenced by lower fluctuation in heart rate and heart rate variability in the high-frequency band. We address the potential underlying biological mechanisms, the influence of covariates on these measures and briefly discuss the specificity and potential for remote monitoring by using these variables.

Binary symbolic dynamics analysis to detect stress-associated changes of nonstationary heart rate variability

“…mental stress, psychosocial stress) on physiological functioning such as the heart rate and heart rate variability has been investigated in numerous studies 23 – 29 . The Trier Social Stress Test as a standardized psychosocial stress procedure has also been investigated with respect to changes of HRV during the procedure 15 , 16 , 30 . However, issues arising from nonstationarities in the analyzed time series caused by the stress testing procedure are rarely addressed 31 .…”

Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self‐regulation, emotion, and interpersonal processes

“…Larger decreases in vmHRV in response to various challenges are associated with less loneliness and greater social sensitivity across multiple measures (Muhtadie et al, ). Further, major depression is associated with smaller decreases in vmHRV in response to evaluative threat (Schiweck, Piette, Berkmans, Claes, & Vrieze, ), although similar effects vary across types of stressors, indications of depression, and age (Hamilton & Alloy, ). Larger decreases in vmHRV in response to laboratory stressors predict less negative affect during daily negative couple interactions, independent of resting levels of vmHRV (Diamond et al, ), and larger decreases in vmHRV in response to a sad film predict less suicidal ideation in psychiatric outpatients (Adolph, Teismann, Forkmann, Wannemüller, & Margraf, ).…”

Traumatic stress and the autonomic brain‐gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

“…Observation studies show that both psychiatric dysfunctions and GI problems are linked with elevated threat-responsive autonomic regulation and difficulty with recovery after challenges. VVC activity (indexed by high frequency heart rate variability; HF-HRV) is depressed or less flexibly regulated in patients with IBS (Liu, Wang, Yan, & Chen, 2013;Mazurak, Seredyuk, Sauer, Teufel, & Enck, 2012), functional nausea and vomiting disorders (Tarbell et al, 2014;To, Issenman, & Kamath, 1999), major depressive disorder (Schiweck, Piette, Berckmans, Claes, & Vrieze, 2019), and a range of anxiety disorders (Chalmers, Quintana, Abbott, & Kemp, 2014).…”