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Spoelma MJ, Serafimovska A, Parker G. Differentiating melancholic and non-melancholic depression via biological markers: A review. World J Biol Psychiatry 2023; 24:761-810. [PMID: 37259772 DOI: 10.1080/15622975.2023.2219725] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Melancholia is a severe form of depression that is typified by greater genetic and biological influence, distinct symptomatology, and preferential response to physical treatment. This paper sought to broadly overview potential biomarkers of melancholia to benefit differential diagnosis, clinical responses and treatment outcomes. Given nuances in distinguishing melancholia as its own condition from other depressive disorder, we emphasised studies directly comparing melancholic to non-melancholic depression. METHODS A comprehensive literature search was conducted. Key studies were identified and summarised qualitatively. RESULTS 105 studies in total were identified. These studies covered a wide variety of biomarkers, and largely fell into three domains: endocrinological (especially cortisol levels, particularly in response to the dexamethasone suppression test), neurological, and immunological (particularly inflammatory markers). Less extensive evidence also exists for metabolic, genetic, and cardiovascular markers. CONCLUSIONS Definitive conclusions were predominantly limited due to substantial heterogeneity in how included studies defined melancholia. Furthermore, this heterogeneity could be responsible for the between- and within-group variability observed in the candidate biomarkers that were examined. Therefore, clarifying these definitional parameters may help identify underlying patterns in biomarker expression to improve diagnostic and therapeutic precision for the depressive disorders.
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Affiliation(s)
- Michael J Spoelma
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | | | - Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Neyer S, Witthöft M, Cropley M, Pawelzik M, Lugo RG, Sütterlin S. Reduction of depressive symptoms during inpatient treatment is not associated with changes in heart rate variability. PLoS One 2021; 16:e0248686. [PMID: 33755668 PMCID: PMC7987172 DOI: 10.1371/journal.pone.0248686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Vagally mediated heart rate variability (HRV) is a psychophysiological indicator of mental and physical health. Limited research suggests there is reduced vagal activity and resulting lower HRV in patients with Major Depressive Disorder (MDD); however little is actually known about the association between HRV and symptoms of depression and whether the association mirrors symptom improvement following psychotherapy. The aim of this study was to investigate the association between antidepressant therapy, symptom change and HRV in 50 inpatients (68% females; 17–68 years) with a diagnosis of MDD. Severity of depressive symptoms was assessed by self-report (Beck Depression Inventory II) and the Hamilton Rating Scale of Depression. Measures of vagally mediated HRV (root mean square of successive differences and high-frequency) were assessed at multiple measurement points before and after inpatient psychotherapeutic and psychiatric treatment. Results showed an expected negative correlation between HRV and depressive symptoms at intake. Depressive symptoms improved (d = 0.84) without corresponding change in HRV, demonstrating a de-coupling between this psychophysiological indicator and symptom severity. To our knowledge, this study is the first to examine an association between HRV and depressive symptoms before and after psychotherapy. The observed de-coupling of depression and HRV, and its methodological implications for future research are discussed.
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Affiliation(s)
| | - Michael Witthöft
- Department for Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Mark Cropley
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | | | - Ricardo Gregorio Lugo
- Department for Information Security and Communication Technology, Norwegian University of Science and Technology, Gjøvik, Norway
- Faculty for Health and Welfare Sciences, Østfold University College, Halden, Norway
| | - Stefan Sütterlin
- Faculty for Health and Welfare Sciences, Østfold University College, Halden, Norway
- Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Davis KM, Iwaniuk ME, Dennis RL, Harris PA, Burk AO. Effects of grazing muzzles on behavior, voluntary exercise, and physiological stress of miniature horses housed in a herd. Appl Anim Behav Sci 2020. [DOI: 10.1016/j.applanim.2020.105108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Davis KM, Iwaniuk ME, Dennis RL, Harris PA, Burk AO. Effects of grazing muzzles on behavior and physiological stress of individually housed grazing miniature horses. Appl Anim Behav Sci 2020. [DOI: 10.1016/j.applanim.2020.105067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Esposito CM, Buoli M. The biological face of melancholia: Are there any reliable biomarkers for this depression subtype? J Affect Disord 2020; 266:802-809. [PMID: 32217262 DOI: 10.1016/j.jad.2020.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/24/2020] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Melancholic depression (MD) is a subtype of Major Depression associated with more clinical severity and poorer prognosis that non-melancholic depression (NMD). The differentiation between depression subtypes is still clinical, although the identification of specific biomarkers could be useful for diagnosis and the development of new treatments. Purpose of the present manuscript is to review the biomarkers that have been associated with MD. METHODS We performed a bibliographic research on the main databases (PubMed, Embase, PsycInfo, Isi Web of Knowledge, Medscape, The Cochrane Library), in order to find studies that proposed biological markers for melancholic depression. A total of 14 studies met our inclusion criteria. RESULTS Most of studies focused on immune dysregulation. Subjects with MD show biological abnormalities than healthy controls (HC). MD might be characterized by specific biological changes and it could be associated to more severe abnormalities with respect to NMD; however especially about this latter point the available data are preliminary. LIMITATIONS Most available data have not been replicated; the studies focused on different biomarkers. In addition, many articles report results on a limited sample size. CONCLUSIONS Melancholic depression is a subtype of major depression that seems to be associated with specific alterations of different biological systems. Future studies with larger sample can confirm the results and hypothesis presented in this review.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy.
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Stuebe AM, Meltzer-Brody S, Propper C, Pearson B, Beiler P, Elam M, Walker C, Mills-Koonce R, Grewen K. The Mood, Mother, and Infant Study: Associations Between Maternal Mood in Pregnancy and Breastfeeding Outcome. Breastfeed Med 2019; 14:551-559. [PMID: 31424266 PMCID: PMC6791474 DOI: 10.1089/bfm.2019.0079] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose: We sought to determine the role of depression and anxiety in breastfeeding cessation. Materials and Methods: Participants underwent a baseline visit with a structured clinical interview in the third trimester of pregnancy. Monthly phone interviews assessed current mood symptoms and infant feeding status. We assessed the association between baseline mood and infant feeding outcomes using Cox proportional hazards regression, adjusting for infant feeding intention and sociodemographic confounders. Results: We enrolled 222 mother-infant dyads in late pregnancy, of whom 206 completed assessments through 12 months postpartum. We enriched our study with symptomatic women by enrolling 87 women with current depression or anxiety (Current), 64 women with a history of depression or anxiety (Past), and 71 women with no psychiatric history (Never). In multivariable-adjusted analyses, baseline diagnosis was not associated with breastfeeding outcome, but baseline symptoms of depression (Beck Depression Inventory ≥11) or anxiety (Spielberger State Anxiety ≥40) were associated with earlier introduction of formula (depression: adj hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.01-2.30; anxiety: 1.70, 95% CI 1.01-2.87); and any cessation of breastfeeding (depression: adj HR 2.02, 95% CI 1.23-3.31; anxiety: 1.83, 95% CI 1.00-3.33), as were depression symptoms among women who were being treated with antidepressants, compared with untreated asymptomatic women (formula: adj HR 2.27, 95% CI 1.29-4.02; cessation: 2.32, 95% CI 1.17-4.61). History of childhood trauma (adj HR 1.34, 95% CI 1.12-1.61), disordered eating symptoms (adj HR 1.22, 95% CI 1.02-1.46), and poor sleep quality in pregnancy (adj HR 1.32, 95% CI 1.09-1.60) were independently associated with earlier introduction of formula. Conclusions: Baseline mood symptoms were independently associated with earlier formula introduction and cessation of breastfeeding. History of childhood trauma, disordered eating symptoms and poor sleep quality were associated with earlier formula introduction. Targeted support may enable women with these symptoms to achieve their feeding goals.
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Affiliation(s)
- Alison M Stuebe
- Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cathi Propper
- Center for Developmental Science, Chapel Hill, North Carolina
| | - Brenda Pearson
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Pamela Beiler
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mala Elam
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cheryl Walker
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Roger Mills-Koonce
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen Grewen
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Sloan RP, Schwarz E, McKinley PS, Weinstein M, Love G, Ryff C, Mroczek D, Choo TH, Lee S, Seeman T. Vagally-mediated heart rate variability and indices of well-being: Results of a nationally representative study. Health Psychol 2016; 36:73-81. [PMID: 27570892 DOI: 10.1037/hea0000397] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE High frequency (HF) heart rate variability (HRV) has long been accepted as an index of cardiac vagal control. Recent studies report relationships between HF-HRV and indices of positive and negative affect, personality traits and well-being but these studies generally are based on small and selective samples. METHOD These relationships were examined using data from 967 participants in the second Midlife in the U.S. (MIDUS II) study. Participants completed survey questionnaires on well-being and affect. HF-HRV was measured at rest. A hierarchical series of regression analyses examined relationships between these various indices and HF-HRV before and after adjustment for relevant demographic and biomedical factors. RESULTS Significant inverse relationships were found only between indices of negative affect and HF-HRV. Relationships between indices of psychological and hedonic well-being and positive affect failed to reach significance. CONCLUSIONS These findings raise questions about relationships between cardiac parasympathetic modulation, emotion regulation, and indices of well-being. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Gayle Love
- Institute on Aging, University of Wisconsin-Madison
| | - Carol Ryff
- Department of Psychology, University of Wisconsin-Madison
| | | | | | | | - Teresa Seeman
- Division of Geriatrics, University of California at Los Angeles
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Rechlin T, Claus D, Weis M, Kaschka W. Decreased heart rate variability parameters in amitriptyline treated depressed patients: biological and clinical significance. Eur Psychiatry 2012; 10:189-94. [PMID: 19698338 DOI: 10.1016/0767-399x(96)80063-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/1993] [Accepted: 05/05/1994] [Indexed: 10/18/2022] Open
Abstract
One hundred-four depressed patients treated with amitriptyline (mean dosage: 163 mg/d; mean plasma level: 239 ng/ml) and 52 normal control subjects matched for age and sex underwent a standardized cardiovascular test battery (various autonomic cardiac parameters, which are largely independent from heart rate, namely the coefficients of variation (CV) while resting and during deep respiration, a spectral analysis of heart rate, the Valsalva ratio, and a posture index were determined). The tests included the determination of time and frequency-derived measurements of heart rate variability (HRV), which is rather independent from heart rate. As compared to the controls the patients showed a significant plasma concentration-dependent decrease of R-R variation in the electrocardiogram (p < 0.0001), while their heart rate was significantly elevated (p < 0.0001). The markedly reduced parameters of sinus arrhythmia in amitriptyline treated patients are suggested to be mainly due to the anticholinergic effect of this drug, although it can not be excluded that the affective disorder itself might be associated with low heart rate variability. The results indicate that autonomic heart rate parameters are a valuable tool for the detection of tricyclic antidepressant (TCA) intake in unconscious patients, especially in intensive care and emergency wards.
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van Zyl LT, Hasegawa T, Nagata K. Effects of antidepressant treatment on heart rate variability in major depression: a quantitative review. Biopsychosoc Med 2008; 2:12. [PMID: 18590531 PMCID: PMC2478652 DOI: 10.1186/1751-0759-2-12] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 06/30/2008] [Indexed: 01/09/2023] Open
Abstract
Background The literature measuring effects of antidepressant and electroconvulsive therapy (ECT) for major depression on heart rate variability (HRV) in medically well individuals was reviewed. Methods Fourteen studies evaluating HRV were included. Twenty three pre-post or within group comparisons were available. Treatment impact on measures of HRV was pooled over studies. We examined different classes of antidepressants, and for short and long electrocardiogram (ECG) recordings separately. Results Tricyclic antidepressants (TCAs) were associated with declines in most measures of HRV and significant increase in heart rate (HR) in studies with short recording intervals. No significant changes were found for longer recording times. Treatment effects with selective serotonin reuptake inhibitors (SSRIs) were more variable. Short-recording studies revealed a significant decrease in HR and an increase in one HRV measure. In two 24-hour recording studies no significant changes were observed. No relationship between ECT and HRV has been established in the literature. The effects of other drugs are reported. Limitations Few studies measure the effects of treatment of depression on HRV. Existing studies have generally used very small samples, employing a variety of measurements and methodologies. Conclusion We confirm that TCAs are associated with a large decrease in HRV and increase HR. However, data for SSRIs is not clear. Although the effect of SSRIs on HRV is weaker than for TCAs, evidence shows that SSRIs are associated with a small decrease in HR, and an increase in one measure of HRV. The use of TCAs in depression leads to changes in HRV that are associated with increased risk of mortality.
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Affiliation(s)
- Louis T van Zyl
- Hamamatsu University, School of Medicine, Japan, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu City, 431-3192, Japan
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Winfield JB. Psychological determinants of fibromyalgia and related syndromes. CURRENT REVIEW OF PAIN 2001; 4:276-86. [PMID: 10953275 DOI: 10.1007/s11916-000-0104-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Fibromyalgia and other chronic pain and fatigue syndromes constitute an increasingly greater societal burden that currently is not being approached effectively by traditional Western medicine. Although the hallmarks of fibromyalgia--chronic widespread pain, fatigue, and multiple other somatic symptoms--have neurophysiologic and endocrinologic underpinnings, these biological aspects derive primarily from psychological variables. Female gender, adverse experiences during childhood, psychological vulnerability to stress, and a stressful, often frightening environment and culture are important antecedents of fibromyalgia. To understand fibromyalgia and related syndromes and to provide optimum care requires a biopsychosocial, not a biomedical, viewpoint.
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Affiliation(s)
- J B Winfield
- Thurston Arthritis Research Center, 3330 C Thurston Building, Campus box # 7280, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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11
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Yoshida T, Yoshino A, Kobayashi Y, Inoue M, Kamakura K, Nomura S. Effects of slow repetitive transcranial magnetic stimulation on heart rate variability according to power spectrum analysis. J Neurol Sci 2001; 184:77-80. [PMID: 11231036 DOI: 10.1016/s0022-510x(00)00505-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We examined whether repetitive transcranial magnetic stimulation (rTMS) at a low rate could influence autonomic function, specially heart rate variability (HRV) by power spectrum analysis. We studied 16 healthy male volunteers as a stimulation group and 16 others as a sham group. The stimulation group received magnetic stimulations from a circular coil over Cz at a frequency of 0.2 Hz and an intensity presenting 90% of the motor threshold. Experiments in both groups included four daily sessions; at each, a train of 70 stimuli was delivered over 350 s. HRV of low-frequency power (LF) in a standing position and high-frequency power (HF) in a supine position were measured before and after each session. After stimulation, HF and LF powers were significantly increased. After sham stimulation, the power of HF but not that of LF significantly increased. Neither actual nor sham stimulation produced a long-term effect detectable on day 5. The finding of transiently increased LF power following actual but not sham stimulation suggests that rTMS may activate the sympathetic nervous system.
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Affiliation(s)
- T Yoshida
- National Defense Medical College, Department of Psychiatry, 3-2 Namiki, Tokorozama 3598513, Japan
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12
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Cohen H, Benjamin J, Geva AB, Matar MA, Kaplan Z, Kotler M. Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatry Res 2000; 96:1-13. [PMID: 10980322 DOI: 10.1016/s0165-1781(00)00195-5] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Power spectral analysis (PSA) of heart rate variability (HRV) offers reliable assessment of cardiovascular autonomic responses, providing a 'window' onto the interaction of peripheral sympathetic and parasympathetic tone. Alterations in HRV are associated with various physiological and pathophysiological processes, and may contribute to morbidity and mortality. Previous studies of posttraumatic stress disorder (PTSD) found lower resting HRV in patients compared to controls, suggesting increased sympathetic and decreased parasympathetic tone. This article describes the analysis of HRV at rest and after psychological stress in panic disorder (PD) patients, in an enlarged sample of PTSD patients, and in healthy control subjects. Standardized heart rate (HR) analysis was carried out in 14 PTSD patients, 11 PD patients and 25 matched controls. ECG recordings were made while subjects were resting ('rest 1'), while recalling the trauma implicated in PTSD, or the circumstances of a severe panic attack, as appropriate ('recall'), and again while resting ('rest 2'). Controls were asked to recall a stressful life event during recall. While both patient groups had elevated HR and low frequency (LF) components of HRV at baseline (suggesting increased sympathetic activity), PTSD patients, unlike PD patients and controls, failed to respond to the recall stress with increases in HR and LF. HRV analysis demonstrates significant differences in autonomic regulation of PTSD and PD patients compared to each other and to control subjects. HRV analysis may augment biochemical studies of peripheral measures in these disorders.
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Affiliation(s)
- H Cohen
- Mental Health Center, Anxiety & Stress Research Unit, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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Cohen H, Neumann L, Shore M, Amir M, Cassuto Y, Buskila D. Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum 2000; 29:217-27. [PMID: 10707990 DOI: 10.1016/s0049-0172(00)80010-4] [Citation(s) in RCA: 248] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess the interaction between the sympathetic and parasympathetic systems in patients with fibromyalgia syndrome (FM), using power spectrum analysis (PSA) of heart rate variability (HRV). In addition, we explored the association between HRV, measures of tenderness, FM symptoms, physical function, psychological well being and quality of life. METHODS We studied 22 women with FM and 22 age-matched healthy women. Twenty-minute electrocardiogram recordings were obtained in a supine position during complete rest. Spectral analysis of R-R intervals was done by the fast-Fourier transform algorithm. RESULTS Heart rate was significantly higher in FM patients compared with controls (P < .006). FM patients had significantly lower HRV compared with controls (P= .001), and higher low-frequency (LF) and lower high-frequency (HF) components of PSA than controls (P < .001). Quality of life, physical function, anxiety, depression, and perceived stress were moderately to highly correlated with LF, HF (in normalized units), and LF/HF. No association was observed between HRV parameters and measures of tenderness and FM symptoms. CONCLUSIONS The basal autonomic state of patients with FM is characterized by increased sympathetic and decreased parasympathetic tones. Autonomic dysregulation may have implications regarding the symptomatology, physical and psychological aspects of health status.
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Affiliation(s)
- H Cohen
- Ministry of Health Mental Health Center, Faculty of Health Sciences, Anxiety and Stress Research Unit, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Althaus M, Mulder LJ, Mulder G, Aarnoudse CC, Minderaa RB. Cardiac adaptivity to attention-demanding tasks in children with a pervasive developmental disorder not otherwise specified (PDD-NOS). Biol Psychiatry 1999; 46:799-809. [PMID: 10494448 DOI: 10.1016/s0006-3223(98)00374-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Decreases in heart rate variability (HRV) have been repeatedly demonstrated to be an index of effort allocation to attention-demanding tasks. Children with autistic-type problems in social interaction and in adapting to unfamiliar situations (DSM-IV: PDD-NOS) have been shown to have specific attention deficits. These children were hypothesized to exhibit less cardiac adaptivity to attention-demanding tasks. METHODS Two groups of 18 children with PDD-NOS, judged to be hyperactive and nonhyperactive, were compared to 18 healthy children with respect to their performances on a visual attention task and the differences in HRV measured during periods of task performance and periods of rest. RESULTS Compared to the control group, both clinical groups were found to have a stronger capacity limitation in processing high loads of information, and to be less capable of maintaining a stable task performance throughout the whole task. Both clinical groups showed significantly less decreases in HRV during the periods of task performance. The magnitude of rest-task differences in HRV was found to correlate significantly with a behavioral measure of resistance to unexpected changes in daily routines. CONCLUSIONS Children with PDD-NOS are significantly less flexible in their autonomic adaptation to attention-demanding tasks. The findings are interpreted as reflecting a deficiency in the functional organization of those neural pathways that provide cortical control of the visceral efferents.
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Affiliation(s)
- M Althaus
- University Center of Child and Adolescent Psychiatry, Groningen, The Netherlands
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15
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Carney RM, Freedland KE, Veith RC, Jaffe AS. Can treating depression reduce mortality after an acute myocardial infarction? Psychosom Med 1999; 61:666-75. [PMID: 10511015 DOI: 10.1097/00006842-199909000-00009] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Major depression affects about one in five patients in the weeks after an acute myocardial infarction and is associated with an increased risk of cardiac morbidity and mortality. Consequently, there is considerable interest in the question of whether treating depression will improve medical prognosis in these patients. Safe, effective treatments for depression are available, but unless they also improve the underlying pathophysiological or behavioral mechanisms that contribute to cardiac morbidity and mortality, they may not have beneficial effects on prognosis. Altered cardiac autonomic tone is one of the leading candidate mechanisms. Unfortunately, a review of the available research reveals that cardiac autonomic tone often fails to normalize in patients treated for depression, and the research suggests that currently available treatments for depression will not necessarily improve cardiac event-free survival in patients who have had an acute myocardial infarction. Until there is convincing evidence that treatment can reduce the risk of cardiac morbidity and mortality, the principal reason to treat depression should continue to be to improve the quality of life of the patient who has had an acute myocardial infarction. Key words: depression, coronary heart disease, mortality.
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Affiliation(s)
- R M Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108, USA
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Ulrich G, Fürstenberg U. Quantitative assessment of dynamic electroencephalogram (EEG) organization as a tool for subtyping depressive syndromes. Eur Psychiatry 1999; 14:217-29. [PMID: 10572351 DOI: 10.1016/s0924-9338(99)80745-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Up until now, no subclassification of affective psychoses has been validated biologically. This follows unavoidably from a research practice of defining diagnostic subtypes in consensus conferences and only thereafter allowing their validation. There is evidence that electroencephalograms (EEG) may be a useful tool in psychiatry, provided that the relevant information is extracted. Our EEG quantification procedure aims at an assessment of both the amount and range of variation of spontaneous changes of topographical alpha-power distribution, developing within a certain period of recording under resting conditions. Our measures were designed to characterize the dynamic organization of the EEG. This is quite obviously an eyeball evaluation but it has nevertheless been neglected in research. The study design was done retrospectively. Included were inpatients with a primary depressive disorder. Main exclusion criteria were an age older than 62 years and psychotropic drugs other than antidepressants. The psychopathology and other clinical data were routinely assessed within three days after admission by the AMDP documentation. An EEG was also routinely performed at admission. We made use of robust, generally known non-parametric statistics. Those patients who exhibited a dynamically rigid EEG are especially prone to recurrences, have a relative late onset of their illness, and show an acute symptomatology characterized by organic-like features. The findings lend support to our contention that the quantitative assessment of the dynamics of the EEG-Gestalt allows the delimitation of a clinically important subtype that is characterized both cross-sectionally and in long-term respects.
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Affiliation(s)
- G Ulrich
- Department of Clinical Psychiatry, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, 14050 Berlin, Germany
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Cohen H, Matar MA, Kaplan Z, Kotler M. Power spectral analysis of heart rate variability in psychiatry. PSYCHOTHERAPY AND PSYCHOSOMATICS 1999; 68:59-66. [PMID: 10026456 DOI: 10.1159/000012314] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Power spectrum analysis of heart rate variability (PSA of HRV) is a promising method, which can be used as an index of cardiac autonomic balance. PSA of HRV is a noninvasive technique, based on ECG sampling of RR interval variation, thus providing a dynamic assessment of sympathetic and parasympathetic tone, reflecting the interactions between the two. It has been shown to have potential value in various laboratory and clinical conditions. It is influenced by many factors such as age, sex, position, breathing, smoking, hour of the day and medications. Different methods of data processing by various authors have often elicited conflicting results. Standard values are not yet available to be used or compared in different settings. From the interest it has raised, it may be expected that this method will be in widespread use in clinical practice in the future, providing a useful tool, both for diagnostic and prognostic purposes, as well as serving as a further aid towards monitoring therapeutic interventions. This review highlights techniques of dynamic assessment of HRV and studies of its clinical applications in psychiatry in particular. It raises the potentially important prognostic implications of protracted autonomic dysfunction in psychiatric patient populations, especially for cardiovascular morbidity and mortality.
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Affiliation(s)
- H Cohen
- Ministry of Health, Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Cohen H, Kotler M, Matar MA, Kaplan Z, Loewenthal U, Miodownik H, Cassuto Y. Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder. Biol Psychiatry 1998; 44:1054-9. [PMID: 9821570 DOI: 10.1016/s0006-3223(97)00475-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Spectral analysis of heart rate variability has recently been shown to be a reliable noninvasive test for quantitative assessment of cardiovascular autonomic regulatory responses, providing a dynamic map of sympathetic and parasympathetic interaction. In a prior study exploring the state of hyperarousal characterizing the posttraumatic stress disorder (PTSD) syndrome, the authors described standardized heart rate analysis carried out in 9 PTSD patients at rest, which demonstrated clear-cut evidence of a baseline autonomic hyperarousal state. METHODS To examine the dynamics of this hyperarousal state, standardized heart rate analysis was carried out in 9 PTSD patients compared to a matched control group of 9 healthy volunteers. Twenty-minute recordings of electrocardiogram in response to a trauma-related cue as opposed to a resting state were performed and analyzed. The PTSD patients were asked to recount the presumed triggering traumatic event, and the control subjects recounted a significant stressful negative life event. RESULTS Our results show that, whereas the control subjects demonstrated significant autonomic responses to the stressogenic stimulus supplied by the recounting of a major stressful experience, the PTSD patients demonstrated almost no autonomic response to the recounting of the triggering stressful event. The PTSD patients demonstrated a degree of autonomic dysregulation at rest which was comparable to that seen in the control subjects' reaction to the stress model. CONCLUSIONS The lack of response to the stress model applied in the study appears to imply that PTSD patients experience so great a degree of autonomic hyperactivation at rest, that they are unable to marshal a further stress response to the recounting of the triggering trauma, as compared to control subjects.
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Affiliation(s)
- H Cohen
- Ministry of Health Mental Health Center, Faculty of Health Sciences, Anxiety and Stress Research Unit, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
The analysis of heart rate variability (HRV) is becoming widely used in clinical research to provide a window into autonomic control of HR. This technique has been valuable in elucidating the autonomic underpinnings of panic disorder (PD), a condition that is marked by reports of heart palpitations. A body of research has emerged that implicates a relative reduction in HRV and cardiac vagal tone in PD, as indicated by various HRV measures. These data are consistent with the cardiac symptoms of panic attacks, as well as with developmental evidence that links high vagal tone with enhanced attention, effective emotion regulation, and organismic responsivity. Implications of these findings for nosology and pathophysiology are discussed. Reports of reduced HRV in PD contrast with portrayals of excess autonomic lability in anxiety. This contradiction is addressed in the context of traditional homeostatic models versus a systems perspective that views physiologic variability as essential to overall stability.
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Affiliation(s)
- B H Friedman
- Department of Psychology, Washington University, St. Louis, Missouri, USA.
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Baumann B, Bornschlegl C, Krell D, Bogerts B. Changes in CSF spaces differ in endogenous and neurotic depression. A planimetric CT scan study. J Affect Disord 1997; 45:179-88. [PMID: 9298431 DOI: 10.1016/s0165-0327(97)00073-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Regional planimetric measurements of internal and external CSF spaces were performed in CT scans of 23 patients with endogenous depression (ICD 9, 296.1) and 28 patients with neurotic depression (ICD 9, 300.4) as compared to 56 control individuals without neuropsychiatric disorder. In female patients with endogenous depression, but not in men, the bilateral upper cortical sulci were widened, especially in the frontal regions, and the third ventricle was enlarged. In contrast, the female neurotic depressed group showed no enlargement of CSF spaces, but a narrowing of the Sylvian fissure and of the basal frontal lobe reaching level of significance in the right fronto-temporal region (P = 0.005). No narrowing of CSF spaces was observed in women with endogenous depression. A discriminant analysis of significantly changed CSF regions resulted in a correct classification in 82.4% of depressed women in either the endogenous or the neurotic group. Determination of divergent types of brain pathology might prove as a useful tool in validating the differential classification of these two main subtypes of affective disorders.
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Affiliation(s)
- B Baumann
- Department of Psychiatry, University of Magdeburg, Germany
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Schultz SK, Anderson EA, van de Borne P. Heart rate variability before and after treatment with electroconvulsive therapy. J Affect Disord 1997; 44:13-20. [PMID: 9186798 DOI: 10.1016/s0165-0327(97)01443-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It has been suggested that depression may be associated with decreased parasympathetic activity. Based on this work, we tested the hypothesis that treatment of depression with electroconvulsive therapy (ECT) would result in a relative increase in cardiac vagal (parasympathetic) activity. Changes in respiratory sinus arrhythmia, a marker of cardiac parasympathetic activity, were examined in nine patients with depressive episodes before and after ECT using spectral analysis. Hamilton Depression Rating Scale scores decreased significantly. In terms of the heart rate measures, RR interval tended to decrease and the amplitude of respiratory sinus arrhythmia decreased significantly following the course of ECT. This reduction in respiratory sinus arrhythmia contributed to the overall decrease in RR interval variability. Additionally, the magnitude of symptom improvement as measured by the Hamilton Scale correlated with the decrease in amplitude of the respiratory sinus arrhythmia. We report that treatment of depression with ECT was associated with a relative decrease in parasympathetic activity, in contrast to our initial hypothesis of a relative increase. This finding may not be related to the ECT per se but rather to the resolution of depression, as there was a significant correlation between the decrease in Hamilton Depression Rating Scale scores and decrease in parasympathetic activity. Further work is necessary to better understand the autonomic changes associated with depressive illness and the clinical risks and benefits associated with various treatment modalities.
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Affiliation(s)
- S K Schultz
- Department of Psychiatry, University of Iowa, College of Medicine, Iowa City, IA 2242, USA.
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Malaspina D, Bruder G, Dalack GW, Storer S, Van Kammen M, Amador X, Glassman A, Gorman J. Diminished cardiac vagal tone in schizophrenia: associations to brain laterality and age of onset. Biol Psychiatry 1997; 41:612-7. [PMID: 9046993 DOI: 10.1016/s0006-3223(96)00161-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We measured high-frequency (rapid) heart rate variability (HRV) from 24-hour Holter electrocardiograms to index cardiovagal tone in 23 patients with DSM-III-R schizophrenia or schizoaffective disorder. High-frequency HRV, quantitated by measuring the percent of successive normal interbeat intervals greater than 50 msec (PNN50), demonstrated a bimodal distribution: 11 of 23 patients had a PNN50 of > and = 8.0 (mean value = 17.7 +/- 11.0), and 12 had a PNN50 of < and = 4.0 (mean value = 1.8 +/- 1.0); no subject had a PNN50 value between 4.0 and 8.0. All 12 low cardiovagal tone patients (versus only 6/11 of the other patients) had a schizophrenia (not schizoaffective) diagnosis (p = .013). PNN50 was not associated with present age, gender, smoking, IQ scores, or symptomatology, but patients with lower cardiovagal tone did have a significantly later age of onset (20.5 +/- 5.3 vs. 14.8 +/- 2.8 years: p = .005). PNN50 subgroups also differed on dichotic listening measures of brain laterality. The low group failed to show left ear (right hemisphere) advantage for complex tones seen in the other patients and normal adults. They also showed larger right ear (left hemisphere) advantage for dichotic words than the other patients. This evidence of relative right hemisphere disadvantage in patients with low cardiovagal tone is consistent with findings linking autonomic nervous system and right hemisphere function. These findings also support the existence of subgroups of schizophrenia patients differing in autonomic activity, brain laterality, and clinical features.
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Affiliation(s)
- D Malaspina
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Rechlin T, Weis M, Spitzer A, Kaschka WP. Are affective disorders associated with alterations of heart rate variability? J Affect Disord 1994; 32:271-5. [PMID: 7897091 DOI: 10.1016/0165-0327(94)90091-4] [Citation(s) in RCA: 200] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A standardized heart rate analysis was carried out in unmedicated patients with major depression, melancholic type (n = 16), panic disorder (n = 16), reactive depression with suicide attempts during the preceding 24 h (n = 16) and in 16 normal control subjects. The investigations included time- and frequency-derived measurements of heart rate variability. In the patients with reactive depression, no differences could be detected as compared with the control group. The patients with panic disorder showed a significantly increased low-frequency band of spectral analysis (P < 0.01) and a marginally significant increment of heart rate (P = 0.05), probably indicating predominance of sympathetic control of heart rate. In the patients with major depression, we found significantly lower values of heart's beat-to-beat intervals and of the high-frequency peak of spectral analysis than in the other groups (P < 0.025), indicating decreased parasympathetic activity.
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Affiliation(s)
- T Rechlin
- Department of Psychiatry, University of Erlangen-Nürnberg, Germany
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