Major depressive disorder with melancholia displays robust alterations in resting state heart rate and its variability: implications for future morbidity and mortality

Abstract

Background: Major depressive disorder (MDD) is associated with increased heart rate and reductions in its variability (heart rate variability, HRV) – markers of future morbidity and mortality – yet prior studies have reported contradictory effects. We hypothesized that increases in heart rate and reductions in HRV would be more robust in melancholia relative to controls, than in patients with non-melancholia.Methods: A total of 72 patients with a primary diagnosis of MDD (age M: 36.26, SE: 1.34; 42 females) and 94 controls (age M: 35.69, SE: 1.16; 52 females) were included in this study. Heart rate and measures of its variability (HRV) were calculated from two 2-min electrocardiogram recordings during resting state. Propensity score matching controlled imbalance on potential confounds between patients with melancholia (n = 40) and non-melancholia (n = 32) including age, gender, disorder severity, and comorbid anxiety disorders.Results: MDD patients with melancholia displayed significantly increased heart rate and lower resting-state HRV (including the square root of the mean squared differences between successive N–N intervals, the absolute power of high frequency and standard deviation of the Poincaré plot perpendicular to the line of identity measures of HRV) relative to controls, findings associated with a moderate effect size (Cohens d’s = 0.56–0.58). Patients with melancholia also displayed an increased heart rate relative to those with non-melancholia (Cohen’s d = 0.20).Conclusion: MDD patients with melancholia – but not non-melancholia – display robust increases in heart rate and decreases in HRV. These findings may underpin a variety of behavioral impairments in patients with melancholia including somatic symptoms, cognitive impairment, reduced responsiveness to the environment, and over the longer-term, morbidity and mortality.

Impact of Comorbid Depressive Disorders on Subjective and Physiological Responses to Emotion in Generalized Anxiety Disorder

“…Similarly, melancholic and atypical subtypes of depression have been associated with distinctive patterns of physiological reactivity and dysregulation (e.g., Fotiou et al 2003; Penninx et al 2013). Melancholia has been shown to feature an overactive stress response indexed by higher heart rate, lower HRV, and elevated serum cortisol, whereas metabolic and inflammatory dysregulation may be more specific to atypical depression (Kemp et al 2014b; Penninx et al 2013). …”

Resting state vagal tone in borderline personality disorder: A meta-analysis

“…Reduced vmHRV relative to controls is reported in major depressive disorder (MDD) (Kemp et al, 2010) and MDD with comorbid generalized anxiety disorder (Kemp et al, 2012), as well as MDD with melancholia (Kemp et al, 2014a(Kemp et al, , 2014b. Reduced vmHRV is also observed in anxiety disorders (Chalmers et al, 2014) such as social anxiety disorder (Alvares et al, 2013), generalized anxiety disorder (Friedman and Thayer, 1998a;Thayer et al, 1996Thayer et al, , 2000, and panic disorder (Cohen et al, 2000;Friedman and Thayer, 1998b).…”

Combining electroencephalographic activity and instantaneous heart rate for assessing brain–heart dynamics during visual emotional elicitation in healthy subjects

“…On the other hand, changes in ANS signalling relevantly affect the CNS, both in physiological and in pathological conditions [2,4,[6][7][8][9]. Dysfunctions of the ANS were found in acute and chronic stressful conditions [10][11][12], insomnia [13,14], epilepsy [15,16], parkinsonisms [17,18], psychosomatic disorders [19] and schizophrenia, anxiety and mood disorders [6,[20][21][22][23][24], which are typically considered CNS-related conditions. Moreover, vagal nerve stimulation has been shown as an effective treatment for major depression [25,26], while relaxation techniques based on cardio-feedback are used for managing negative emotions and psychological symptoms [27,28].…”