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Bylsma LM, DeMarree KG, McMahon TP, Park J, Biehler KM, Naragon-Gainey K. Resting vagally-mediated heart rate variability in the laboratory is associated with momentary negative affect and emotion regulation in daily life. Psychophysiology 2024:e14668. [PMID: 39177251 DOI: 10.1111/psyp.14668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 07/10/2024] [Accepted: 08/02/2024] [Indexed: 08/24/2024]
Abstract
Vagally-mediated heart rate variability (vmHRV) is a physiological index reflecting parasympathetic activity that has been linked to emotion regulation (ER) capacity. However, very limited research has examined associations of physiological indices of regulation such as vmHRV with emotional functioning in daily life. The few studies that exist have small samples sizes and typically focus on only a narrow aspect of ER or emotional functioning. In this study, we examined associations between vmHRV assessed in the laboratory and emotional/mental health functioning in daily life using a 7-day ecological momentary assessment design in 303 adult community participants. We hypothesized that higher resting vmHRV would be associated with higher positive affect (PA), lower negative affect (NA), less affective variability, greater well-being, fewer dysphoria symptoms, greater use of engagement ER strategies, and less use of avoidance ER strategies, as assessed in daily life. Results revealed that higher resting vmHRV in the laboratory (as indexed by both high frequency heart rate variability, HF-HRV, and the root mean of successive square deviations between heart beats, RMSSD) was significantly associated with less frequent use of avoidance ER strategies in daily life. Theoretical and clinical implications are discussed, including the association of vmHRV with negatively valenced, rather than positively valenced, daily life experiences.
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Affiliation(s)
- Lauren M Bylsma
- Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth G DeMarree
- Department of Psychology, University at Buffalo, The State University of New York (SUNY), Buffalo, New York, USA
| | - Tierney P McMahon
- School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
| | - Juhyun Park
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Kaitlyn M Biehler
- Department of Psychology, University at Buffalo, The State University of New York (SUNY), Buffalo, New York, USA
| | - Kristin Naragon-Gainey
- School of Psychological Science, University of Western Australia, Western Australia, Australia
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Xie F, Zhou L, Hu Q, Zeng L, Wei Y, Tang X, Gao Y, Hu Y, Xu L, Chen T, Liu H, Wang J, Lu Z, Chen Y, Zhang T. Cardiovascular variations in patients with major depressive disorder versus bipolar disorder. J Affect Disord 2023; 341:219-227. [PMID: 37657620 DOI: 10.1016/j.jad.2023.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Differentiating depression in major depressive disorder and bipolar disorder is challenging in clinical practice. Therefore, reliable biomarkers are urgently needed to differentiate between these diseases. This study's main objective was to assess whether cardiac autonomic function can distinguish patients with unipolar depression (UD), bipolar depression (BD), and bipolar mania (BM). METHODS We recruited 791 patients with mood disorders, including 191 with UD, 286 with BD, and 314 with BM, who had been drug free for at least 2 weeks. Cardiovascular status was measured using heart rate variability (HRV) and pulse wave velocity (PWV) indicators via finger photoplethysmography during a 5-min rest period. RESULTS Patients with BD showed lower HRV but higher heart rates than those with UD and BM. The PWV indicators were lower in the UD group than in the bipolar disorder group. The covariates of age, sex, and body mass index affected the cardiovascular characteristics. After adjusting for covariates, the HRV and PWV variations among the three groups remained significant. Comparisons between the UD and BD groups showed that the variable with the largest effect size was the frequency-domain indices of HRV, very low and high frequency, followed by heart rate. The area under the receiver operating characteristic curve (AUC) for each cardiovascular variable ranged from 0.661 to 0.714. The High-frequency index reached the highest AUC. LIMITATIONS Cross-sectional design and the magnitude of heterogeneity across participants with mood disorders limited our findings. CONCLUSION Patients with BD, but not BM, had a greater extent of cardiac imbalance than those with UD. Thus, HRV may serve as a psychophysiological biomarker for the differential diagnosis of UD and BD.
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Affiliation(s)
- Fei Xie
- School of Public Health, Fudan University, Shanghai, China; Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - LinLin Zhou
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Qiang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China; Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, China
| | - LingYun Zeng
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, ShenZhen, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - YuQing Gao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Ontario, Canada; Labor and Worklife Program, Harvard University, MA, United States
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai 200240, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Zheng Lu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai 200065, China.
| | - YingYao Chen
- School of Public Health, Fudan University, Shanghai, China.
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China.
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Kim J, Kim JJ, Seok JH, Kim E, Park JY, Kim HE, Oh J. Association and interaction between clinician-rated measures of depression and anxiety with heart rate variability in elderly patients with psychiatric disorders. Heliyon 2023; 9:e20740. [PMID: 37860509 PMCID: PMC10582342 DOI: 10.1016/j.heliyon.2023.e20740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Background Older adults are vulnerable to comorbid depression and anxiety symptoms; however, these conditions are widely underrecognized and often untreated. Understanding their combined manifestation using objective measurements, such as clinician-rated scales and heart rate variability (HRV), can help refine the diagnosis and select a treatment strategy for geriatric patients. Methods This study included patients over 65 years who were mainly diagnosed with either category of depressive or anxiety disorders from the psychiatric outpatient clinic in a university hospital. A total of 114 patients met eligibility with a completed collection of electrocardiograms, the Hamilton Depression Rating Scale (HDRS; clinician-rated depression), and the Hamilton Anxiety Scale (HAS; clinician-rated anxiety) to assess the severity of symptoms. Both main and interaction effects between HDRS and HAS on HRV parameters were examined. Results Significant interaction effects between clinician-rated depression and anxiety (HDRS × HAS) on HRV reduction in frequency parameters (i.e., nuLF, nuHF, LF/HF ratio) were found, which consistently indicated autonomic nervous system dysregulation. Findings imply that HRV could reflect synergistic effects of comorbid depressive and anxiety symptoms, perhaps due to the amplification of individual symptoms in geriatric patients. Conclusions The results imply that using objective measurements can improve diagnostic accuracy, particularly in geriatric patients with comorbid status, and the normalization of the autonomic nervous system might be a candidate target for prevention and treatment.
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Affiliation(s)
- Joonbeom Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunjoo Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Hesun Erin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Oh
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Verhoeven JE, Han LKM, Lever-van Milligen BA, Hu MX, Révész D, Hoogendoorn AW, Batelaan NM, van Schaik DJF, van Balkom AJLM, van Oppen P, Penninx BWJH. Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. J Affect Disord 2023; 329:19-29. [PMID: 36828150 DOI: 10.1016/j.jad.2023.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Antidepressant medication and running therapy are both effective treatments for patients with depressive and anxiety disorders. However, they may work through different pathophysiological mechanisms and could differ in their impact on physical health. This study examined effects of antidepressants versus running therapy on both mental and physical health. METHODS According to a partially randomized patient preference design, 141 patients with depression and/or anxiety disorder were randomized or offered preferred 16-week treatment: antidepressant medication (escitalopram or sertraline) or group-based running therapy ≥2 per week. Baseline (T0) and post-treatment assessment at week 16 (T16) included mental (diagnosis status and symptom severity) and physical health indicators (metabolic and immune indicators, heart rate (variability), weight, lung function, hand grip strength, fitness). RESULTS Of the 141 participants (mean age 38.2 years; 58.2 % female), 45 participants received antidepressant medication and 96 underwent running therapy. Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881). However, the groups differed significantly on various changes in physical health: weight (d = 0.57; p = .001), waist circumference (d = 0.44; p = .011), systolic (d = 0.45; p = .011) and diastolic (d = 0.53; p = .002) blood pressure, heart rate (d = 0.36; p = .033) and heart rate variability (d = 0.48; p = .006). LIMITATIONS A minority of the participants was willing to be randomized; the running therapy was larger due to greater preference for this intervention. CONCLUSIONS While the interventions had comparable effects on mental health, running therapy outperformed antidepressants on physical health, due to both larger improvements in the running therapy group as well as larger deterioration in the antidepressant group. TRIAL REGISTRATION Trialregister.nl Number of identification: NTR3460.
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Affiliation(s)
- Josine E Verhoeven
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands.
| | - Laura K M Han
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Bianca A Lever-van Milligen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Mandy X Hu
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Dóra Révész
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Digna J F van Schaik
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
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Ricka N, Pellegrin G, Fompeyrine DA, Lahutte B, Geoffroy PA. Predictive biosignature of major depressive disorder derived from physiological measurements of outpatients using machine learning. Sci Rep 2023; 13:6332. [PMID: 37185788 PMCID: PMC10130089 DOI: 10.1038/s41598-023-33359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Major Depressive Disorder (MDD) has heterogeneous manifestations, leading to difficulties in predicting the evolution of the disease and in patient's follow-up. We aimed to develop a machine learning algorithm that identifies a biosignature to provide a clinical score of depressive symptoms using individual physiological data. We performed a prospective, multicenter clinical trial where outpatients diagnosed with MDD were enrolled and wore a passive monitoring device constantly for 6 months. A total of 101 physiological measures related to physical activity, heart rate, heart rate variability, breathing rate, and sleep were acquired. For each patient, the algorithm was trained on daily physiological features over the first 3 months as well as corresponding standardized clinical evaluations performed at baseline and months 1, 2 and 3. The ability of the algorithm to predict the patient's clinical state was tested using the data from the remaining 3 months. The algorithm was composed of 3 interconnected steps: label detrending, feature selection, and a regression predicting the detrended labels from the selected features. Across our cohort, the algorithm predicted the daily mood status with 86% accuracy, outperforming the baseline prediction using MADRS alone. These findings suggest the existence of a predictive biosignature of depressive symptoms with at least 62 physiological features involved for each patient. Predicting clinical states through an objective biosignature could lead to a new categorization of MDD phenotypes.
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Affiliation(s)
| | | | | | - Bertrand Lahutte
- Psychiatry Department, Bégin Military Hospital, 94160, Saint-Mandé, France
| | - Pierre A Geoffroy
- Psychiatry and Addictology Service, Assistance Publique-Hôpitaux de Paris, GHU Paris Nord, DMU Neurosciences, Hopital Bichat-Claude Bernard, 75018, Paris, France
- GHU Paris-Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université de Paris, 75019, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000, Strasbourg, France
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Noble NC, Merker JB, Webber TK, Ressler KJ, Seligowski AV. PTSD and depression severity are associated with cardiovascular disease symptoms in trauma-exposed women. Eur J Psychotraumatol 2023; 14:2234810. [PMID: 37470387 PMCID: PMC10360993 DOI: 10.1080/20008066.2023.2234810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 07/21/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) and depression are associated with increased risk for cardiovascular disease (CVD), which is the leading cause of death and disability worldwide. Epidemiological studies have revealed these illnesses to be highly comorbid, particularly among women. In the current study, we explored associations between indices of cardiovascular health, PTSD, and depression among a sample of trauma-exposed individuals assigned female at birth.Methods: Participants were N = 49 individuals without CVD who reported lifetime Criterion A trauma exposure. Blood pressure (BP), heart rate (HR), and high-frequency heart rate variability (HF-HRV) were collected during a 5-minute resting period. Symptoms of CVD (e.g. extremity pain and swelling, shortness of breath), PTSD, and depression were assessed, along with an exploratory measure of anhedonia.Results: Trauma exposure was positively correlated with systolic BP (r = .32, p = .029) and diastolic BP (r = .30, p = .040). The number of reported CVD symptoms was positively correlated with symptoms of PTSD (r = .41, p = .004), depression (r = .40, p = .005) and anhedonia (r = .38, p = .007). CVD symptoms were also significantly associated with PTSD (β = .41, t = 2.43, p = .023), depression (β = .40, t = 2.76, p = .009), and anhedonia (β = .38, t = 2.51, p = .017) after controlling for age and trauma exposure. These associations were not moderated by HF-HRV in our sample.Conclusions: Our results support the association between PTSD and depressive symptoms and worse cardiovascular functioning among an often-overlooked population that is particularly vulnerable to these illnesses. Future studies should investigate residual impacts of PTSD and depression treatment on CVD risk among trauma-exposed individuals, particularly women.
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Affiliation(s)
| | | | | | - Kerry J Ressler
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Antonia V Seligowski
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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A recent suicide attempt and the heartbeat: Electrophysiological findings from a trans-diagnostic cohort of patients and healthy controls. J Psychiatr Res 2023; 157:257-263. [PMID: 36516500 DOI: 10.1016/j.jpsychires.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/28/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
Suicidal behavior is influenced by a multitude of factors, making prediction and prevention of suicide attempts (SA) a challenge. A useful tool to uncover underlying pathophysiology or propose new therapy approaches are biomarkers, especially within the context of point-of-care tests. Heart rate variability (HRV) is a well-established biomarker of mental health, and measures the activity of the sympathetic and parasympathetic nervous system (PNS). Previous studies reported a correlation between lower PNS activity and suicidality. However, most studies involved participants from a healthy population, patients without history of suicide attempts, or patients with a single diagnosis. 52 in-patients with a recent suicide attempt (<6 months), and 43 controls without history of SA or psychiatric diagnoses confirmed study participation. The included patients age ranged between 18 and 65 years, 65% had psychiatric comorbidities. Patients with dementia, cognitive impairments, acute psychosis, chronic non suicidal self-harming behavior, or current electroconvulsive therapy were excluded. A 15-min resting state electrocardiography was recorded with two bipolar electrodes attached to the right and left insides of the wrists. The multiple regression analyses showed lower parasympathetic, and higher sympathetic activity in patients compared to controls. Partial correlation found a positive trend result between self-reported suicidality and the very low frequency band. ROC curve analysis revealed an acceptable to excellent clinical accuracy of HRV parameters. Therefore, HRV parameters could be reliable discriminative biomarkers between in-patients with a recent SA and healthy controls. One limitation is the lack of a control group consisting of in-patients without life-time suicidal ideation or attempts.
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Hong S, Park DH, Ryu SH, Ha JH, Jeon HJ. Association between Heart Rate Variability Indices and Depressed Mood in Patients with Panic Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:737-746. [PMID: 36263648 PMCID: PMC9606434 DOI: 10.9758/cpn.2022.20.4.737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 07/22/2023]
Abstract
Objective Heart rate variability (HRV) reflects the regulation of the autonomic nervous system. Panic disorder is highly associated with autonomic dysfunction, and is often accompanied by depression. The aim of this study is to determine the association between depression and HRV indices in patients with panic disorder. Methods A total of 110 outpatients diagnosed with panic disorder participated in this study. The medical records of patients with panic disorder who visited the outpatient clinic of Konkuk University Hospital between December 2018 and March 2020 were retrospectively reviewed. Measurements used in this study include the Panic Disorder Severity Scale-Self Report, Beck Depression Inventory (BDI-II), Insomnia Severity Index, and HRV. Patients were divided into depressive and non-depressive groups based on their BDI-II scores. The association between HRV indices and depressive symptoms was statistically analyzed. Results The low frequency/high frequency (LF/HF) ratio was reduced in patients with depression (mean = -0.095, p = 0.004 in the above moderate depressive group, mean = -0.120, p = 0.020 in the severe depressive group). Significant correlations were found between depressive symptoms and standard deviation of NN interval (SDNN) (ms) (-0.19, p = 0.044), very low frequency (VLF) (ms2/Hz) (-0.22, p = 0.021), LF (-0.25, p = 0.008), HF (-0.19, p = 0.043), and LF/HF (-0.25, p = 0.009). Multiple linear regression analysis showed that BDI predicted SDNN (ms), VLF (ms2/Hz), LF, HF, and LF/HF. Conclusion We confirmed that the LF/HF ratio decreases when depression is accompanied by panic disorder. HRV indices may be useful markers for detecting depressive symptoms in patients with panic disorder.
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Affiliation(s)
- Sumin Hong
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Korea
| | - Doo-Heum Park
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Korea
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Korea
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea
| | - Jee Hyun Ha
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Korea
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Korea
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea
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Gilbert P, Basran JK, Raven J, Gilbert H, Petrocchi N, Cheli S, Rayner A, Hayes A, Lucre K, Minou P, Giles D, Byrne F, Newton E, McEwan K. Compassion Focused Group Therapy for People With a Diagnosis of Bipolar Affective Disorder: A Feasibility Study. Front Psychol 2022; 13:841932. [PMID: 35936292 PMCID: PMC9347420 DOI: 10.3389/fpsyg.2022.841932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Compassion focused therapy (CFT) is an evolutionary informed, biopsychosocial approach to mental health problems and therapy. It suggests that evolved motives (e.g., for caring, cooperating, competing) are major sources for the organisation of psychophysiological processes which underpin mental health problems. Hence, evolved motives can be targets for psychotherapy. People with certain types of depression are psychophysiologically orientated towards social competition and concerned with social status and social rank. These can give rise to down rank-focused forms of social comparison, sense of inferiority, worthlessness, lowered confidence, submissive behaviour, shame proneness and self-criticism. People with bipolar disorders also experience elevated aspects of competitiveness and up rank status evaluation. These shift processing to a sense of superiority, elevated confidence, energised behaviour, positive affect and social dominance. This is the first study to explore the feasibility of a 12 module CFT group, tailored to helping people with a diagnosis of bipolar disorder understand the impact of evolved competitive, status-regulating motivation on their mental states and the value of cultivating caring and compassion motives and their psychophysiological regulators. Methods Six participants with a history of bipolar disorder took part in a CFT group consisting of 12 modules (over 25 sessions) as co-collaborators to explore their personal experiences of CFT and potential processes of change. Assessment of change was measured via self-report, heart rate variability (HRV) and focus groups over three time points. Results Although changes in self-report scales between participants and across time were uneven, four of the six participants consistently showed improvements across the majority of self-report measures. Heart rate variability measures revealed significant improvement over the course of the therapy. Qualitative data from three focus groups revealed participants found CFT gave them helpful insight into: how evolution has given rise to a number of difficult problems for emotion regulation (called tricky brain) which is not one's fault; an evolutionary understanding of the nature of bipolar disorders; development of a compassionate mind and practices of compassion focused visualisations, styles of thinking and behaviours; addressing issues of self-criticism; and building a sense of a compassionate identity as a means of coping with life difficulties. These impacted their emotional regulation and social relationships. Conclusion Although small, the study provides evidence of feasibility, acceptability and engagement with CFT. Focus group analysis revealed that participants were able to switch from competitive focused to compassion focused processing with consequent improvements in mental states and social behaviour. Participants indicated a journey over time from 'intellectually' understanding the process of building a compassionate mind to experiencing a more embodied sense of compassion that had significant impacts on their orientation to (and working with) the psychophysiological processes of bipolar disorder.
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Affiliation(s)
- Paul Gilbert
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
- The Compassionate Mind Foundation, Derby, United Kingdom
| | - Jaskaran K. Basran
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
- The Compassionate Mind Foundation, Derby, United Kingdom
| | - Joanne Raven
- The Compassionate Mind Foundation, Derby, United Kingdom
| | - Hannah Gilbert
- The Compassionate Mind Foundation, Derby, United Kingdom
- Department of Psychology, University of Roehampton, London, United Kingdom
| | - Nicola Petrocchi
- Department of Economics and Social Sciences, John Cabot University, Rome, Italy
- Compassionate Mind ITALIA, Rome, Italy
| | - Simone Cheli
- School of Human Health Sciences, University of Florence, Florence, Italy
| | - Andrew Rayner
- The Compassionate Mind Foundation, Derby, United Kingdom
| | - Alison Hayes
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Kate Lucre
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Paschalina Minou
- Department of Philosophy, University College London, London, United Kingdom
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - David Giles
- Lattice Coaching and Training, Chesterfield, United Kingdom
| | - Frances Byrne
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Elizabeth Newton
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Kirsten McEwan
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
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10
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Rouch I, Edjolo A, Celle S, Pichot V, Laurent B, Borg C, Dorey JM, Roche F. Association between depressive symptoms and long-term heart rate variability in older women: Findings from a population-based cohort. J Affect Disord 2022; 305:151-158. [PMID: 35219741 DOI: 10.1016/j.jad.2022.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cross-sectional studies highlighted changes in autonomic nervous system (ANS) activity in geriatric depression. However, few longitudinal studies assessed this link which remains still debated. We examined the longitudinal association between lifetime depression history, current depressive disorders, and the evolution of ANS activity in older community women. METHODS The present data stemmed from the PROOF study, a population-based cohort of 1011 community-dwellers followed-up at 2-year intervals for 10 years. Only data from female participants was analyzed (n = 508, mean age 68.5 ± 0.88 years), as very few men had depression in our population. Depressive symptoms and depression history were collected at baseline. Participants were classified in four groups according to presence or absence of history of depression (HD) or current depressive symptomatology (CD): HD+/CD+, HD-/CD+, HD+/CD- and HD-/CD-. ANS activity was assessed during the follow-up through 24-h heart rate variability (HRV). Longitudinal associations between depressive status and HRV indices during the follow-up were investigated using multivariate linear mixed models. RESULTS Compared to HD-/CD- group, women belonging to HD-/CD+ group had greater baseline parasympathetic tone, as measured by lower LF index and LF/HF balance. The longitudinal analysis exhibited a significant enhancement of LF/HF balance with time, measuring an increase of sympathetic tone in HD-/CD+ group. CONCLUSION Our findings suggest that late-onset depressive symptoms may be associated with subsequent autonomic dysregulation in older women. These results highlight the importance of detecting and managing depressive symptoms to limit their consequences on ANS functioning, and the risk of cardiovascular events.
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Affiliation(s)
- Isabelle Rouch
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France.; INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France.
| | - Arlette Edjolo
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France.; INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Sébastien Celle
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France.; INSERM SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France
| | - Vincent Pichot
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France.; INSERM SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France
| | - Bernard Laurent
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France.; INSERM, U1028; CNRS, UMR5292; Neuropain Team, Lyon Neuroscience Research Center, Lyon, F-69000, France
| | - Céline Borg
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
| | | | - Frédéric Roche
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France.; INSERM SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France
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11
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Berger M, Seemüller F, Voggt A, Obermeier M, Kirchberg F, Löw A, Riedel M, von Schacky C, Severus E. Omega-3 fatty acids in bipolar patients with a low omega-3 index and reduced heart rate variability: the "BIPO-3" trial. Int J Bipolar Disord 2022; 10:9. [PMID: 35362878 PMCID: PMC8975918 DOI: 10.1186/s40345-022-00253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Research suggests that a low omega-3 index may contribute to the low heart rate variability and the increased risk of cardiovascular morbidity and mortality in bipolar disorders. However, so far, no intervention trial with EPA and DHA has been conducted in bipolar patients attempting to increase their heart rate variability. Methods 119 patients with bipolar disorder according to DSM-IV were screened, with 55 euthymic bipolar patients—owing to inclusion criteria (e.g. low omega-3 index (< 6%), SDNN < 60 ms.)—being enrolled in a randomized, double-blind, 12-week parallel study design with omega-3 fatty acids (4 capsules of 530 mg EPA, 150 mg DHA) or corn oil as a placebo, in addition to usual treatment. Heart rate variability as well as the omega-3 index were measured at baseline and at the endpoint of the study. Results A total of 42 patients (omega-3: n = 23, corn oil: n = 19) successfully completed the study after 12 weeks. There was a significant increase in the omega-3 index (value at endpoint minus value at baseline) in the omega-3 group compared to the corn oil group (p < 0.0001). However, there was no significant difference in the change of the SDNN (value at endpoint minus value at baseline) between the treatment groups (p = 0.22). In addition, no correlation between changes in SDNN and change in the omega-3 index could be detected in the omega-3 group (correlation coefficient = 0.02, p = 0.94) or the corn oil group (correlation coefficient = − 0.11, p = 0.91). Similarly, no significant differences between corn oil and omega-3 group regarding the change of LF (p = 0.19), HF (p = 0.34) and LF/HF ratio (p = 0.84) could be demonstrated. Conclusions In our randomized, controlled intervention trial in euthymic bipolar patients with a low omega-3 index and reduced heart rate variability no significant effect of omega-3 fatty acids on SDNN or frequency-domain measures HF, LF and LF/HF ratio could be detected. Possible reasons include, among others, the effect of psychotropic medication present in our trial and/or the genetics of bipolar disorder itself. Further research is needed to test these hypotheses. Trial registration ClinicalTrials.gov, NCT00891826. Registered 01 May 2009–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT00891826
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Affiliation(s)
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Psychiatry, Psychosomatic and Psychotherapy, Kbo-Lech-Mangfall-Clinic Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Alessandra Voggt
- St. Joseph Krankenhaus, Klinik Für Seelische Gesundheit Im Kindes- Und Jugendalter, Berlin, Germany
| | | | - Franca Kirchberg
- Division of Metabolic and Nutritional Medicine, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anja Löw
- Department of Internal Medicine I - Cardiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.,Marion Von Tessin Memory-Zentrum gGmbH, Munich, Germany
| | - Clemens von Schacky
- Department of Preventive Cardiology, Ludwig- Maximilians-Universität München, Munich, Germany.,Omegametrix, GmbH, Planegg, Germany
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, TU Dresden, Dresden, Germany.
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12
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Krause-Utz A, Walther JC, Kyrgiou AI, Hoogenboom W, Alampanou M, Bohus M, Schmahl C, Lis S. Severity of childhood maltreatment predicts reaction times and heart rate variability during an emotional working memory task in borderline personality disorder. Eur J Psychotraumatol 2022; 13:2093037. [PMID: 35816658 PMCID: PMC9262367 DOI: 10.1080/20008198.2022.2093037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED Background: Difficulties in emotion regulation are a core symptom of borderline personality disorder (BPD) and often interfere with cognitive functions, such as working memory (WM). Traumatic childhood experiences, including severe maltreatment, can contribute to emotion dysregulation, possibly mediated by changes in high-frequency heart rate variability (HF-HRV). However, it is not yet entirely understood if HF-HRV alterations underlie impaired WM during emotional distraction in BPD and if this is related to traumatic childhood experiences and to comorbid post-traumatic stress disorder (PTSD). Objective: Our aim was to investigate performance (reaction times, RTs) and HF-HRV during an emotional working memory task (EWMT) in relation to childhood maltreatment severity and comorbid PTSD in BPD. Method: Eighty-one women (n = 28 healthy controls (HC) and n = 53 BPD patients of which n = 18 had comorbid PTSD) performed an adapted Sternberg item recognition WM task with neutral and negative social cues (interpersonal scenes from the International Affective Picture System (IAPS), and neutral, fearful, and angry faces) as distractors. Dependent variables were RTs of correct trials and HF-HRV. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire. Results: Compared to healthy participants, patients with BPD showed prolonged RTs across all distractor conditions with social cues, regardless of their emotional valence. Patients with BPD, especially those with PTSD, demonstrated reduced HF-HRV both at rest and during EWMT. Severity of childhood maltreatment predicted longer RTs and lower HF-HRV during the EWMT. Conclusions: Findings suggest that adverse childhood experiences accelerate difficulties in shifting attention away from social information and that these are more pronounced in individuals with BPD. Reduced HF-HRV (low parasympathetic-tonus) may be an important psychophysiological mechanism underlying impaired WM in the presence of distracting social cues in patients with BPD, especially in those with comorbid PTSD. HIGHLIGHTS This study provides evidence that childhood maltreatment experiences are associated with hypersensitivity to social information and reduced high-frequency heart rate variability during a working memory task in borderline personality disorder.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Julia-Caroline Walther
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Akrivi I Kyrgiou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - William Hoogenboom
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Myrto Alampanou
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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13
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Vagedes J, Kuderer S, Helmert E, Vagedes K, Kohl M, Szőke H, Beissner F, Joos S, Andrasik F. The Immediate Effect of Sinapis nigra and Zingiber officinale as Thermogenic Substances during Footbaths: A Randomized Controlled Crossover Trial. Complement Med Res 2021; 29:213-222. [PMID: 34933309 PMCID: PMC9677831 DOI: 10.1159/000521590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Warm footbaths infused with Sinapis nigra (mustard, or MU) or Zingiber officinale (ginger, or GI) are used for various thermoregulatory conditions, but little is known about how they are perceived by individuals, both short- and long-term. We analyzed the immediate and long-term effects of MU and GI on warmth and stimulus perception in healthy adults. METHODS Seventeen individuals (mean age 22.1±2.4 years; 11 female) received three footbaths (mean temperature was 40 ± 0.2°C, administered between 1:30 and 6:30 p.m.) in a randomized order with a crossover design: 1. with warm water only (WA), 2. with warm water and MU, and 3. with warm water and GI. Warmth and stimulus perception at the feet were assessed at the 1st, 5th, 10th, 15th, and 20th minute of the footbaths, in the late evening (EVE), and the following morning (MG). We further assessed well-being (at EVE and MG) and sleep quality (at MG). The primary outcome measure was the warmth perception at the feet at the 10th minute of the footbath. RESULTS At the 10th minute of the footbath, warmth perception at the feet was significantly higher with MU and GI compared to WA. The immediate thermogenic effects pointed to a quick increase in warmth and stimulus perception with MU, a slower increase with GI, and a gradual decrease with WA. Regarding the long-term effects, warmth and stimulus perception were still higher after GI compared to WA at EVE and MG. No differences were seen for general well-being and sleep quality. CONCLUSION Thermogenic substances can significantly alter the dynamics of warmth and stimulus perception when added to footbaths. The different profiles in the application of GI and MU could be relevant for a more differentiated and specific use of both substances in different therapeutic indications.
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Affiliation(s)
- Jan Vagedes
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
- Department of Neonatology, University Hospital Tübingen, Tübingen, Germany
| | - Silja Kuderer
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - Eduard Helmert
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - Katrin Vagedes
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - Matthias Kohl
- Institute of Precision Medicine, University Furtwangen, Villingen-Schwenningen, Germany
| | - Henrik Szőke
- Department of Integrative Medicine, University of Pécs, Pécs, Hungary
| | - Florian Beissner
- Insula Institute for Integrative Therapy Research, Hannover, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
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14
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Ethnic discrimination and depressed mood: The role of autonomic regulation. J Psychiatr Res 2021; 144:110-117. [PMID: 34619489 DOI: 10.1016/j.jpsychires.2021.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/09/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Perceived ethnic discrimination (PED) is thought to underlie increased prevalence of depressed mood in ethnic minorities. Depression is associated with increased sympathetic and decreased parasympathetic activity. We investigated a biopsychosocial model linking PED, disrupted sympathovagal balance and depressed mood. Baseline data of HELIUS, a cohort study on health among a multi-ethnic population, was used. Heart rate variability (HRV), baroreflex sensitivity (BRS), PED (evaluated with the Everyday Discrimination Scale) and presence of depressed mood (evaluated with the Patient Health Questionnaire-9) were assessed. Associations of PED, HRV/BRS and depressed mood were analyzed with linear and logistic regression analyses. Mediation of the association of PED and depressed mood by HRV/BRS was assessed in a potential outcomes model and four steps mediation analysis. Of 9492 included participants, 14.7% fulfilled criteria for depressed mood. Higher PED was associated with depressed mood (P < .001). Lower autonomic regulation indexes were associated with depressed mood (deltaR2 = 0.4-1.1%, P < .001) and at most weakly with PED (deltaR2 = 0.2-0.3%, P < .001). A very modest mediating effect by HRV/BRS in the association between PED and depressed mood was attenuated after adjustment for socioeconomic status. To conclude, we found no support for the hypothesis that autonomic regulation relevantly mediates the association between PED and depression.
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15
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Poli A, Gemignani A, Soldani F, Miccoli M. A Systematic Review of a Polyvagal Perspective on Embodied Contemplative Practices as Promoters of Cardiorespiratory Coupling and Traumatic Stress Recovery for PTSD and OCD: Research Methodologies and State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11778. [PMID: 34831534 PMCID: PMC8619958 DOI: 10.3390/ijerph182211778] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
Baseline respiratory sinus arrhythmia (RSA) has been proposed as a transdiagnostic biomarker of stress vulnerability across psychopathologies, and a reliable association between PTSD, OCD and lower resting RSA was found. Contemplative practices have been linked to the activation of the vagus as well as to an increased RSA that, according to the polyvagal theory, reflects the activation of the ventral vagal complex (VVC) and may promote PTSD and OCD recovery. PubMed and Scopus databases were selected to conduct a search following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines, and A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality for this systematic review. Six articles met the inclusion criteria (one cross-sectional study, one study with pre-post measurements, two cohort studies and two RCT studies). Mindfulness-related interventions promoted parasympathetic activity, an increased vagal tone and improvements in PTSD and OCD symptoms. According to the polyvagal theory, mindfulness-related and compassion-related meditations would be conceptualized as neural exercises expanding the capacity of the ventral vagal complex to regulate the present state and to promote resilience. Clinical and methodological issues are discussed.
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Affiliation(s)
- Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | | | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
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16
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Effects of a dance program on psychophysiological variables in hospitalized patients with depression: A mixed model approach. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2021.101857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Wang YC, Wang CC, Yao YH, Wu WT. Identification of a High-Risk Group of New-Onset Cardiovascular Disease in Occupational Drivers by Analyzing Heart Rate Variability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111486. [PMID: 34770003 PMCID: PMC8582774 DOI: 10.3390/ijerph182111486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/01/2023]
Abstract
Purpose: This cohort study evaluated the effectiveness of noninvasive heart rate variability (HRV) analysis to assess the risk of cardiovascular disease over a period of 8 years. Methods: Personal and working characteristics were collected before biochemistry examinations and 5 min HRV tests from the Taiwan Bus Driver Cohort Study (TBDCS) in 2005. This study eventually identified 161 drivers with cardiovascular disease (CVD) and 627 without between 2005 and 2012. Estimation of the hazard ratio was analyzed by using the Cox proportional-hazards model. Results: Subjects with CVD had an overall lower standard deviation of NN intervals (SDNN) than their counterparts did. The SDNN index had a strong association with CVD, even after adjusting for risk factors. Using a median split for SDNN, the hazard ratio of CVD was 1.83 (95% CI = 1.10–3.04) in Model 1 and 1.87 (95% CI = 1.11–3.13) in Model 2. Furthermore, the low-frequency (LF) index was associated with a risk of CVD in the continuous approach. For hypertensive disease, the SDNN index was associated with increased risks in both the continuous and dichotomized approaches. When the root-mean-square of the successive differences (RMSSDs), high frequency (HF), and LF were continuous variables, significant associations with hypertensive disease were observed. Conclusions: This cohort study suggests that SDNN and LF levels are useful for predicting 8 year CVD risk, especially for hypertensive disease. Further research is required to determine preventive measures for modifying HRV dysfunction, as well as to investigate whether these interventions could decrease CVD risk among professional drivers.
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Affiliation(s)
- Ying-Chuan Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (Y.-C.W.); (C.-C.W.)
- Division of Occupational Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chung-Ching Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (Y.-C.W.); (C.-C.W.)
- Division of Occupational Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ya-Hsin Yao
- School of Medicine, National Defense Medical Center, Taipei 114, Taiwan;
| | - Wei-Te Wu
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Healthcare Administration, Asia University, Taichung 413, Taiwan
- Correspondence:
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18
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The effects of inducing self-compassion on affective and physiological recovery from a psychosocial stressor in depression. Behav Res Ther 2021; 146:103965. [PMID: 34530317 DOI: 10.1016/j.brat.2021.103965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/12/2020] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
The current study was designed to extend previous research by testing whether self-compassion acts as a protective factor that facilitates faster affective and physiological recovery from stress in people with elevated depressive symptoms. Specifically, we examined the effect of experimentally induced self-compassion on positive affect, negative affect, and respiratory sinus arrhythmia (RSA) recovery from stress. Participants (N = 59) experiencing elevated depressive symptoms completed the Trier Social Stress Test (TSST), a standardized psychosocial stressor, and then were randomly assigned to either a self-compassion induction or a no-strategy control induction before resting quietly during the 30-min recovery period. During the induction period, participants in the self-compassion condition exhibited a greater increase in positive affect and a trend towards a greater decrease in negative affect than did participants in the no-strategy control condition. However, the psychological benefits of self-compassion did not continue during the post-induction recovery period. Moreover, changes in RSA levels did not differ between participants in the self-compassion and no-strategy control condition. These results suggest that, among individuals with elevated depressive symptoms, brief self-compassion inductions have short-term beneficial psychological, but not physiological, effects. As such, our findings delineate the benefits and boundaries of single-session self-compassion inductions in depression, and in doing so, inform future experimental and applied research.
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19
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Brupbacher G, Zander-Schellenberg T, Straus D, Porschke H, Infanger D, Gerber M, von Känel R, Schmidt-Trucksäss A. The Acute Effects of Aerobic Exercise on Nocturnal and Pre-Sleep Arousal in Patients with Unipolar Depression: Preplanned Secondary Analysis of a Randomized Controlled Trial. J Clin Med 2021; 10:jcm10174028. [PMID: 34501476 PMCID: PMC8432550 DOI: 10.3390/jcm10174028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/03/2021] [Accepted: 09/03/2021] [Indexed: 12/28/2022] Open
Abstract
Unipolar depression is associated with insomnia and autonomic arousal. The aim of this study was to quantify the effect of a single bout of aerobic exercise on nocturnal heart rate variability and pre-sleep arousal in patients with depression. This study was designed as a two-arm, parallel-group, randomized, outcome assessor-blinded, controlled, superiority trial. Patients with a primary diagnosis of unipolar depression aged 18-65 years were included. The intervention consisted of a single 30 min moderate-intensity aerobic exercise bout. The control group sat and read for 30 min. The primary outcome of interest was RMSSD during the sleep period assessed with polysomnography. Secondary outcomes were additional heart rate variability outcomes during the sleep and pre-sleep period as well as subjective pre-sleep arousal. A total of 92 patients were randomized to either the exercise (N = 46) or the control (N = 46) group. Intent-to-treat analysis ANCOVA of follow-up sleep period RMSSD, adjusted for baseline levels and minimization factors, did not detect a significant effect of the allocation (β = 0.12, p = 0.94). There was no evidence for significant differences between both groups in any other heart rate variability measure nor in measures of cognitive or somatic pre-sleep arousal. As this is the first trial of its kind in this population, the findings need to be confirmed in further studies. Patients with depression should be encouraged to exercise regularly in order to profit from the known benefits on sleep and depressive symptoms, which are supported by extensive literature.
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland; (D.I.); (A.S.-T.)
- OBERWAID AG, Rorschacher Strasse 311, 9016 St. Gallen, Switzerland; (D.S.); (H.P.)
- Correspondence:
| | - Thea Zander-Schellenberg
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, 4055 Basel, Switzerland;
| | - Doris Straus
- OBERWAID AG, Rorschacher Strasse 311, 9016 St. Gallen, Switzerland; (D.S.); (H.P.)
| | - Hildburg Porschke
- OBERWAID AG, Rorschacher Strasse 311, 9016 St. Gallen, Switzerland; (D.S.); (H.P.)
| | - Denis Infanger
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland; (D.I.); (A.S.-T.)
| | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland;
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland;
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland; (D.I.); (A.S.-T.)
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20
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Buchhorn R, Baumann C, Willaschek C. Pathophysiological mechanisms of bradycardia in patients with anorexia nervosa. Health Sci Rep 2021; 4:e331. [PMID: 34322602 PMCID: PMC8299991 DOI: 10.1002/hsr2.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this investigation was to examine heart rate variability (HRV), interbeat interval (IBI), and their interrelationship in healthy controls, bradycardic hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) mutation carriers, and patients with anorexia nervosa (AN). We tested the hypothesis that neural mechanisms cause bradycardia in patients with AN. Therefore, we assumed that saturation of the HRV/IBI relationship as a consequence of sustained parasympathetic control of the sinus node is exclusively detectable in patients with AN. METHODS Patients with AN between the ages of 12 and 16 years admitted to our hospital due to malnutrition were grouped and included in the present investigation (N = 20). A matched-pair group with healthy children and adolescents was created. Groups were matched for age and sex. A 24-hour Holter electrocardiography (ECG) was performed in controls and patients. More specifically, all patients underwent two 24-hour Holter ECG examinations (admission; refeeding treatment). Additionally, the IBI was recorded during the night in HCN4 mutation carriers (N = 4). HRV parameters were analyzed in 5-minute sequences during the night and plotted against mean corresponding IBI length. HRV, IBI, and their interrelationship were examined using Spearman's rank correlation analyses, Mann-Whitney U tests, and Wilcoxon signed-rank tests. RESULTS The relationship between IBI and HRV showed signs of saturation in patients with AN. Furthermore, signs of HRV saturation were present in two HCN4 mutation carriers. In contrast, signs of HRV saturation were not present in controls. CONCLUSIONS The existence of HRV saturation does not support the existence of parasympathetically mediated bradycardia. Nonneural mechanisms, such as HCN4 downregulation, may be responsible for bradycardia and HRV saturation in patients with AN.
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Affiliation(s)
- Reiner Buchhorn
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
| | | | - Christian Willaschek
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
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21
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Jo HG, Shin N. Heart Rate Variability as an Early Objective Indicator of Subjective Feeling of Depression in Daily Life. Healthc Inform Res 2021; 27:249-254. [PMID: 34384207 PMCID: PMC8369054 DOI: 10.4258/hir.2021.27.3.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 05/28/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives Changes in the autonomic nervous system have been observed in patients with depressive disorders by measuring their heart rate variability (HRV). However, whether HRV associates with depressive events in healthy people remains unknown. Methods Four healthy people participated in the present study. Their HRVs were measured routinely for 6 to 13 months. During this time, two participants reported experiencing two and three bouts of depression, respectively. This approach allowed us to examine changes in the participants’ HRVs by comparing their HRVs from before and after the unexpected depressive events. Changes in HRV were compared against those of two participants who did not report any depressive event. Results Participants’ low frequency/high frequency (LF/HF) ratios of HRV were lower after the event of depression than before. Their LF/HF ratios increased after recovery from the depressive events. In contrast, two participants who did not report any depressive event showed relatively smaller changes in their LF/HF ratios across measurements. Conclusions These results suggest that the LF/HF ratio may provide an objective measure of subjective experiences of depression and help identify potential cases of clinical depression.
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Affiliation(s)
- Han-Gue Jo
- School of Computer Information and Communication Engineering, Kunsan National University, Gunsan, Korea
| | - Nara Shin
- Human Rights Center, Konkuk University, Seoul, Korea
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22
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Warm Footbaths with Sinapis nigra or Zingiber officinale Enhance Self-Reported Vitality in Healthy Adults More than Footbaths with Warm Water Only: A Randomized, Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9981183. [PMID: 34335853 PMCID: PMC8292049 DOI: 10.1155/2021/9981183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
Objectives To examine the effects of warm footbaths with thermogenic medicinal powders on vitality and heart rate variability in healthy adults. Intervention and Outcome. Seventeen healthy young adults (22.1 ± 2.4 years, 11 females) received three footbaths (WA: warm water only; GI: warm water and ginger; MU: warm water and mustard) in randomized order with a crossover design. We assessed vitality with the Basler Befindlichkeit questionnaire (BBS) and heart rate variability (HRV) before (t0), immediately after (t1), and 10 minutes following footbaths (t2). The primary outcome measure was self-reported vitality, measured via the BBS, at t1. Results The primary outcome measure, self-reported vitality, was higher after GI and tended to be higher after MU compared to WA with medium effect sizes (GI vs. WA, mean difference −2.47 (95% CI −5.28 to 0.34), padj=0.048, dadj = 0.74), MU vs. WA, −2.35 (−5.32 to 0.61), padj=0.30, dadj = 0.50). At t2, the standard deviation of beat-to-beat intervals (SDNN) of HRV increased, and the stress index tended to decrease after all three footbath conditions with small to medium effect sizes (0.42–0.66). Conclusion There is preliminary evidence that footbaths with thermogenic agents GI and MU may increase self-reported vitality during a short-time period with a more pronounced effect with GI. After a short follow-up, all three conditions tended to shift the autonomic balance towards relaxation. Future research should investigate these effects in clinical samples with a larger, more diverse sample size.
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23
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Hasebe H, Shinba T. Decreased anxiety after catheter ablation for paroxysmal atrial fibrillation is associated with augmented parasympathetic reactivity to stress. Heart Rhythm O2 2021; 1:189-199. [PMID: 34113873 PMCID: PMC8183861 DOI: 10.1016/j.hroo.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Psychological improvement after catheter ablation for atrial fibrillation (AF) has been reported, but its mechanism is unclear. Objective This study aimed to clarify the relationship between cardiac autonomic modification and psychological changes after catheter ablation for paroxysmal AF (PAF). Methods Thirty-five consecutive patients (60.5 ± 11.9 years; male, n = 24) with PAF treated by catheter ablation were enrolled. Autonomic activity and reactivity to stress and psychological status were measured before (baseline) and at 1 and 3 months after ablation. We assessed autonomic activity and reactivity to stress by measuring heart rate variability (HRV) at rest (Rest), and during (Task) and after (After) the execution of a task and assessed relationships between HRV parameters and psychological changes using the State-Trait Anxiety Inventory (STAI) and Self-Rating Depression Scale (SDS). Results The STAI state and trait scores significantly decreased at 3 months compared with baseline, whereas SDS scores essentially remained unchanged. The high-frequency (HF) response index (Task/Rest) and HF recovery index (After/Rest) were significantly higher than baseline at 3 months (0.40 [0.29–0.90] vs 1.30 [0.64–2.18], P = .007 for HF response index; 1.13 [0.92–2.19] vs 1.87 [1.19–2.97], P = .049 for HF recovery index). Reductions in STAI scores positively correlated with increments in the HF recovery index in the entire cohort as well as in 5 patients with recurrent AF. Conclusions Some augmentation of parasympathetic reactivity to stress correlated with reduced anxiety, implying that cardiac autonomic modification plays roles in psychological improvement after catheter ablation for AF.
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Affiliation(s)
- Hideyuki Hasebe
- Department of Arrhythmology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Toshikazu Shinba
- Department of Psychiatry, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
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24
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Michael JA, Kaur M. The Heart-Brain Connection in Depression: Can it inform a personalised approach for repetitive transcranial magnetic stimulation (rTMS) treatment? Neurosci Biobehav Rev 2021; 127:136-143. [PMID: 33891972 DOI: 10.1016/j.neubiorev.2021.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/30/2022]
Abstract
There is growing enthusiasm into the frontal-vagal network theory of major depressive disorder (MDD) and the potential role of a frontal-vagal network in the therapeutic mechanism of repetitive transcranial magnetic stimulation (rTMS) treatment for MDD. A review of the autonomic nervous system (ANS) in MDD and its role in antidepressant treatment for MDD is timely. The literature supports the well-established notion of ANS dysfunction in MDD and the benign effect of selective serotonin reuptake inhibitors, but not tricyclic antidepressants, on perturbed ANS function in MDD. Notwithstanding, there is some evidence that ANS measures have the capacity to inform response to antidepressant medication treatment. While there is a paucity of studies on the effects of rTMS on the ANS, critically, there is preliminary support that rTMS may alleviate ANS dysfunction in MDD and that ANS measures are associated with rTMS treatment response. These observations are consistent with the frontal-vagal theory of depression and the emerging literature on the use of ANS measures for personalising and optimising rTMS treatment of MDD.
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Affiliation(s)
- Jessica A Michael
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia
| | - Manreena Kaur
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
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25
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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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26
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Yang JH, Choi SH, Lee MH, Oh SM, Choi JW, Park JE, Park KS, Lee YJ. Association of heart rate variability with REM sleep without atonia in idiopathic REM sleep behavior disorder. J Clin Sleep Med 2021; 17:461-469. [PMID: 33112228 DOI: 10.5664/jcsm.8934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
STUDY OBJECTIVES Idiopathic rapid eye movement sleep behavior disorder (iRBD), characterized by rapid eye movement sleep without atonia (RSWA) and dream-enactment behavior, has been suggested to be a predictor of α-synucleinopathies. Autonomic instability, represented by heart rate variability, is a common characteristic of both iRBD and α-synucleinopathies. Previous studies reported that RSWA was associated with autonomic dysfunction and was a possible predictor of phenoconversion. Therefore, we sought to compare heart rate variability between iRBD and control groups and explore the relationship between heart rate variability and RSWA in patients with iRBD. METHODS Nocturnal polysomnographic data on 47 patients (28 men, 19 women) diagnosed with iRBD based on video-polysomnography and 26 age-matched and sex-matched controls were reviewed. The first 5-minute epoch with a stable electrocardiogram lead II on video-polysomnography was selected from stage N2, wake, and rapid eye movement. For quantification of RSWA, tonic activity was analyzed from the submentalis electromyogram and phasic activity from the submentalis and bilateral anterior tibialis electromyogram channels. RESULTS Compared to the control group, the iRBD group showed significant reductions in the standard deviation of the R-R intervals, the root mean square of successive R-R interval differences, and high-frequency values. Quantified tonic activity was inversely correlated with normalized low-frequency values and low-frequency/high-frequency ratios and positively correlated with normalized high-frequency values. CONCLUSIONS This study implied decreased cardiac autonomic function in patients with iRBD, which showed parasympathetic predominance. Heart rate variability of the patients with iRBD in this study was associated with quantified tonic RSWA, which was previously reported to be a possible predictor of phenoconversion.
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Affiliation(s)
- Jeong Hun Yang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Ho Choi
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Mi Hyun Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Min Oh
- Department of Psychiatry, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jae-Won Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwang Suk Park
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, Republic of Korea.,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
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Campbell KSJ, Collier AC, Irvine MA, Brain U, Rurak DW, Oberlander TF, Lim KI. Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation. Front Psychiatry 2021; 12:680177. [PMID: 34483982 PMCID: PMC8415315 DOI: 10.3389/fpsyt.2021.680177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants increases risk for adverse neurodevelopmental outcomes, yet little is known about whether effects are present before birth. In relation to maternal SRI pharmacokinetics, this study investigated chronic and acute effects of prenatal SRI exposure on third-trimester fetal heart rate variability (HRV), while evaluating confounding effects of maternal depressed mood. Methods: At 36-weeks' gestation, cardiotocograph measures of fetal HR and HRV were obtained from 148 pregnant women [four groups: SRI-Depressed (n = 31), SRI-Non-Depressed (n = 18), Depressed (unmedicated; n = 42), and Control (n = 57)] before, and ~5-h after, typical SRI dose. Maternal plasma drug concentrations were quantified at baseline (pre-dose) and four time-points post-dose. Mixed effects modeling investigated group differences between baseline/pre-dose and post-dose fetal HR outcomes. Post hoc analyses investigated sex differences and dose-dependent SRI effects. Results: Maternal SRI plasma concentrations were lowest during the baseline/pre-dose fetal assessment (trough) and increased to a peak at the post-dose assessment; concentration-time curves varied widely between individuals. No group differences in fetal HR or HRV were observed at baseline/pre-dose; however, following maternal SRI dose, short-term HRV decreased in both SRI-exposed fetal groups. In the SRI-Depressed group, these post-dose decreases were displayed by male fetuses, but not females. Further, episodes of high HRV decreased post-dose relative to baseline, but only among SRI-Non-Depressed group fetuses. Higher maternal SRI doses also predicted a greater number of fetal HR decelerations. Fetuses exposed to unmedicated maternal depressed mood did not differ from Controls. Conclusions: Prenatal SRI exposure had acute post-dose effects on fetal HRV in late gestation, which differed depending on maternal mood response to SRI pharmacotherapy. Importantly, fetal SRI effects were sex-specific among mothers with persistent depressive symptoms, as only male fetuses displayed acute HRV decreases. At trough (pre-dose), chronic fetal SRI effects were not identified; however, concurrent changes in maternal SRI plasma levels suggest that fetal drug exposure is inconsistent. Acute SRI-related changes in fetal HRV may reflect a pharmacologic mechanism, a transient impairment in autonomic functioning, or an early adaption to altered serotonergic signaling, which may differ between males and females. Replication is needed to determine significance with postnatal development.
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Affiliation(s)
- Kayleigh S J Campbell
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Abby C Collier
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ursula Brain
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Dan W Rurak
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth I Lim
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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28
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Orosz A, Federspiel A, Eckert A, Seeher C, Dierks T, Tschitsaz A, Cattapan K. Exploring the effectiveness of a specialized therapy programme for burnout using subjective report and biomarkers of stress. Clin Psychol Psychother 2020; 28:852-861. [PMID: 33283948 DOI: 10.1002/cpp.2539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
The increasing prevalence of stress-related disorders such as burnout urges the need for specialized treatment approaches. Programmes combining psychotherapy and regenerative interventions emerge to be the most successful. However, evaluated therapy programmes are scarce and usually involve subjective symptom quantification without consideration of physiologic parameters. The aim of the present exploratory, single-group study was the multimodal investigation of the effectiveness of a specialized holistic therapy programme by assessing symptoms and biological markers of chronic stress. Seventy-one in-patients (39 men/32 women; age 46.8 ± 9.9 years) of a specialized burnout ward with the additional diagnosis of burnout (Z73.0) in conjunction with a main diagnosis of depressive disorder (F32 or F33) according to the International Classification of Diseases (ICD)-10 were included in the study. In addition to symptomatology, the stress-responsive biomarkers heart rate variability (HRV) and serum brain-derived neurotrophic factor (BDNF) were measured in patients at admittance to and discharge from the burnout ward applying a 6-week specialized treatment programme. At discharge, patients showed a significant reduction of symptom burden and a significant increase in serum BDNF, while HRV remained unchanged. The findings implicate that the therapy programme may have beneficial effects on symptomatology and neuroplasticity of patients with burnout. As therapy was often supplemented by psychopharmacological treatment, a relevant influence of antidepressant medication especially on BDNF has to be considered.
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Affiliation(s)
- Ariane Orosz
- Centre for Stress-Related Illnesses, Sanatorium Kilchberg, Private Clinic for Psychiatry and Psychotherapy, Kilchberg, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
| | - Andrea Federspiel
- University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
| | - Anne Eckert
- Neurobiology Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform Molecular and Cognitive Neuroscience (MCN), University of Basel, Psychiatric University Clinics Basel, Basel, Switzerland
| | - Christian Seeher
- Centre for Stress-Related Illnesses, Sanatorium Kilchberg, Private Clinic for Psychiatry and Psychotherapy, Kilchberg, Switzerland
| | - Thomas Dierks
- University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
| | - Armita Tschitsaz
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern, Moosseedorf, Switzerland
| | - Katja Cattapan
- Centre for Stress-Related Illnesses, Sanatorium Kilchberg, Private Clinic for Psychiatry and Psychotherapy, Kilchberg, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
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Giurgi-Oncu C, Tudoran C, Enatescu VR, Tudoran M, Pop GN, Bredicean C. Evolution of Heart Rate Variability and Heart Rate Turbulence in Patients with Depressive Illness Treated with Selective Serotonin Reuptake Inhibitors. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E590. [PMID: 33167574 PMCID: PMC7694481 DOI: 10.3390/medicina56110590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: Major depressive disorder (MDD) and cardiovascular diseases (CVDs) represent serious and prevalent medical conditions. Autonomic nervous system (ANS) dysfunctions, expressed by parameters of heart rate variability (HRV) and heart rate turbulence (HRT), have been repeatedly associated with depression. The aim of our study was to identify potential HRV and HRT alterations in patients with MDD, before and after selective serotonin reuptake inhibitor (SSRI) therapy, and to observe any correlations between these parameters and the severity of depressive symptoms. Another aim was to evidence if there was a normalization or improvement of HRV and HRT parameters that paralleled the reduction of the intensity of depressive symptoms. Materials and Methods: We studied heart rate variability (HRV) and heart rate turbulence (HRT) in a sample of 78 patients, aged under 51 years, who were referred to our outpatient clinic between June 2017 and December 2019, for complaints in the context of a new onset major depressive disorder (MDD), before and after therapy with SSRIs. Results: By using 24 h Holter ECG monitoring, we evidenced alterations of HRV and HRT parameters, significantly correlated with the severity of depressive symptoms (p < 0.001), as assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS). Our results indicated that these parameters improved following one and six months of SSRI therapy, when a partial or total remission of depressive symptoms was achieved (p < 0.001). Changes in HRV parameters were correlated with the reduction of the severity of depression. Conclusions: In our study group, we highlighted, through 24 h ECG Holter monitoring, frequent and clear HRV and HRT abnormalities that were statistically correlated with the severity of depressive symptoms. Furthermore, we were able to document a progressive improvement of these parameters, which corresponded with the improvement of depressive symptoms under SSRI therapy, when compared to the values measured before the commencement of antidepressant pharmacotherapy.
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Affiliation(s)
- Catalina Giurgi-Oncu
- Discipline of Psychiatry, Department of Neuroscience, University of Medicine and Pharmacy “Victor Babes” Timisoara, Eftimie Murgu Place Nr. 2, 300041 Timis, Romania; (C.G.-O.); (V.R.E.); (C.B.)
| | - Cristina Tudoran
- Discipline of Cardiology, Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, Eftimie Murgu Place Nr. 2, 300041 Timis, Romania; (M.T.); (G.N.P.)
| | - Virgil Radu Enatescu
- Discipline of Psychiatry, Department of Neuroscience, University of Medicine and Pharmacy “Victor Babes” Timisoara, Eftimie Murgu Place Nr. 2, 300041 Timis, Romania; (C.G.-O.); (V.R.E.); (C.B.)
| | - Mariana Tudoran
- Discipline of Cardiology, Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, Eftimie Murgu Place Nr. 2, 300041 Timis, Romania; (M.T.); (G.N.P.)
| | - Gheorghe Nicusor Pop
- Discipline of Cardiology, Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, Eftimie Murgu Place Nr. 2, 300041 Timis, Romania; (M.T.); (G.N.P.)
| | - Cristina Bredicean
- Discipline of Psychiatry, Department of Neuroscience, University of Medicine and Pharmacy “Victor Babes” Timisoara, Eftimie Murgu Place Nr. 2, 300041 Timis, Romania; (C.G.-O.); (V.R.E.); (C.B.)
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30
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Singla S, Jhamb S, Singh KD, Kumar A. Depression affects autonomic system of the body? Yes, it does! JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:217. [PMID: 33062750 PMCID: PMC7530411 DOI: 10.4103/jehp.jehp_627_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Depression is a disorder of the brain, a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings, and sense of well-being and can cause alteration in sympathetic activity of the body, thus affecting heart rate variability (HRV). AIM The study was conducted to determine the effects of depression on HRV parameters in clinically known cases of depression. MATERIALS AND METHODS A cross-sectional (observational) study was conducted on fifty known patients of depression, aged 18-65 years, and fifty healthy, age-matched, normal controls. HRV test was conducted, and the results were analyzed statistically using Student's "t"-test for equal variance, for various parameters. RESULTS The study showed that the differences in mean R-R interval(s), mean HR (beats/min), very low frequency (VLF) power (milliseconds squared [ms2]), and low frequency/high frequency (LF/HF) power (%) (LF/HF ratio) among controls and cases were statistically highly significant, while the differences in LF power (ms2) in controls and cases were statistically significant. However, the differences in basic anthropometric parameters, STD (standard deviation of the normal to normal)(s), root mean square successive difference (ms), NN50 (count), pNN50 (%), VLF peak (Hz), LF peak (Hz), HF peak (Hz), HF power (ms2), VLF power (%), LF power (%), HF power (%), LF power (nu), and HF power (nu) were found to be statistically insignificant. CONCLUSION Depression leads to changes in autonomic control of the body and changes the autonomic balance in favor of an increased sympathetic tone, which can be detected with fair accuracy with HRV analysis.
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Affiliation(s)
- Sheena Singla
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| | - Shikha Jhamb
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| | - Kamal Dev Singh
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| | - Avnish Kumar
- Department of Physiology, Government Medical College, Patiala, Punjab, India
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Zandstra T, Kiès P, Man SC, Maan A, Bootsma M, Vliegen H, Egorova A, Holman E, Schalij M, Jongbloed M. QT interval variability and heart rate turbulence are associated with clinical characteristics in congenital heart disease patients with a systemic right ventricle. J Cardiol 2020; 76:514-520. [PMID: 32665161 DOI: 10.1016/j.jjcc.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND QT interval variability (QTV) and heart rate turbulence (HRT) are measures of cardiac autonomic function, which, when abnormal, are correlated with ventricular arrhythmias and worse clinical outcome. This study aims to evaluate QTV and HRT in patients with a systemic right ventricle (RV) and to assess correlations with clinical characteristics. METHODS In a retrospective cohort study, QTV and HRT were derived from 24-h Holter registrations of patients with a systemic RV and healthy controls. QTV and HRT were compared between groups. In patients, the association between QTV, HRT, and clinical characteristics was assessed. RESULTS Holter recordings from 40 patients (mean age 40 years, 16 females) and 37 healthy controls (mean age 42 years, 21 females) were analyzed. Groups were comparable in terms of age and sex. QTV was increased in patients compared with controls (p < 0.001), HRT did not differ significantly between the groups. Increased QTV and decreased HRT correlated with medication use, especially of diuretics, and with clinical events, particularly supraventricular arrhythmias. Increased QTV correlated with reduced systemic RV function. Decreased HRT was independently associated with a larger number of past clinical events (estimate -0.33, 95% CI -0.63 to -0.02, p = 0.037). QTV was higher in women in both patients and controls (p = 0.041 and p = 0.034, respectively). CONCLUSIONS QTV and HRT are associated with clinical factors and events in patients with a systemic RV. Further studies are mandatory to confirm their prognostic value.
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Affiliation(s)
- Tjitske Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sum-Che Man
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arie Maan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia Egorova
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eduard Holman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
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Zandstra T, Kiès P, Maan A, Man SC, Bootsma M, Vliegen H, Egorova A, Mertens B, Holman E, Schalij M, Jongbloed M. Association between reduced heart rate variability components and supraventricular tachyarrhythmias in patients with a systemic right ventricle. Auton Neurosci 2020; 227:102696. [PMID: 32623323 DOI: 10.1016/j.autneu.2020.102696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/24/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with a systemic right ventricle are prone to develop heart failure. Abnormal heart rate variability (HRV), a measure of autonomic dysfunction, is associated with morbidity and mortality in patients with left ventricular failure. The association between HRV and supraventricular arrhythmias (SVTs), which are associated with adverse events in this population, was assessed. METHODS 24-Hour Holter recordings of patients with a systemic right ventricle and healthy controls were analysed in a retrospective cohort study. HRV was calculated and compared between groups. Correlation coefficients were determined for HRV variables and clinical characteristics. The relation between HRV and SVTs was investigated with linear regression. RESULTS The patient group included 29 patients (69%) late after Mustard or Senning correction for transposition of the great arteries, and 13 patients with congenitally corrected transposition of the great arteries (31%). The control group included 38 subjects. HRV was significantly lower in patients compared with controls. In the patient group, lower SDANN (standard deviation of the average NN intervals calculated over 5-minute intervals) was independently associated with a higher number of supraventricular arrhythmias (95% CI -0.03 to -0.0004, p = 0.045). In exploratory correlation analysis, several HRV variables correlated with echocardiographic systemic right ventricular function (rho = 0.36, p = 0.02 for SDANN), and exercise capacity (rho = 0.39, p = 0.05 for SDANN). CONCLUSION In patients with a systemic right ventricle, HRV is lower compared with controls and (SDANN) is independently associated with supraventricular arrhythmias.
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Affiliation(s)
- Tjitske Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Arie Maan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Sum-Che Man
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hubert Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Anastasia Egorova
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Bart Mertens
- Department of Statistics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Eduard Holman
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Monique Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands.
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Jopling E, Gotlib IH, LeMoult J. Effects of working memory training on cognitive, affective, and biological responses to stress in major depression: A novel cognitive bias modification protocol. J Affect Disord 2020; 265:45-51. [PMID: 31957691 PMCID: PMC7050386 DOI: 10.1016/j.jad.2020.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Over 320 million individuals are living with Major Depressive Disorder (MDD), a leading cause of disability worldwide. Thus, there is a crucial need to identify processes that contribute to the maintenance of depressive episodes. Difficulty removing negative information from working memory (WM) is posited to exacerbate affective, cognitive, and biological dysregulation in Major Depressive Disorder (MDD), but this has not yet been tested empirically. METHODS In this study we examined whether training depressed individuals to remove negative information from WM (RNI training) would reduce symptoms of depression and levels of rumination, and would be associated with attenuated biological responsivity to stress. Individuals diagnosed with MDD were randomly assigned to complete Real-RNI training or Sham-RNI training for six days. RESULTS Across conditions, participants exhibited significant improvements from pre- to post-training in removing negative information from WM, symptoms of depression, and rumination. Furthermore, participants in the Real-RNI condition showed a more attenuated pattern of cortisol and respiratory sinus arrhythmia (RSA) responses to stress than did participants in the Sham-RNI training condition. LIMITATIONS We did not assess the long-term effects of training. It will be important for future research to examine whether the documented training-related effects persist across time. CONCLUSIONS This study is the first to examine the effects of RNI training on clinical symptoms and biological responses to stress in MDD, and it provides experimental evidence that training individuals with depression to remove negative information from WM can help to modulate the heightened biological responses to stress seen in depression.
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Affiliation(s)
- Ellen Jopling
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T1Z4, Canada.
| | | | - Joelle LeMoult
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T1Z4, Canada
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Hu MX, Milaneschi Y, Lamers F, Nolte IM, Snieder H, Dolan CV, Penninx BWJH, de Geus EJC. The association of depression and anxiety with cardiac autonomic activity: The role of confounding effects of antidepressants. Depress Anxiety 2019; 36:1163-1172. [PMID: 31622521 PMCID: PMC6916630 DOI: 10.1002/da.22966] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/22/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Depression and anxiety may unfavorably impact on cardiac autonomic dysregulation. However, it is unclear whether this relationship results from a causal effect or may be attributable to confounding factors. We tested the relationship between depression and anxiety with heart rate (HR) and heart rate variability (HRV) across a 9-year follow-up (FU) period and investigated possible confounding by antidepressant use and genetic pleiotropy. METHODS Data (no. of observations = 6,994, 65% female) were obtained from the longitudinal Netherlands Study of Depression and Anxiety, with repeated waves of data collection of HR, HRV, depression, anxiety, and antidepressant use. Summary statistics from meta-analyses of genome-wide association studies were used to derive polygenic risk scores of depression, HR, and HRV. RESULTS Across the 9-year FU, generalized estimating equations analyses showed that the relationship between cardiac autonomic dysregulation and depression/anxiety rendered nonsignificant after adjusting for antidepressant use. A robust association was found between antidepressant use (especially tricyclic antidepressants, selective serotonin, and noradrenalin reuptake inhibitors) and unfavorable cardiac autonomic activity across all waves. However, no evidence was found for a genetic correlation of depression with HR and HRV, indicating that confounding by genetic pleiotropy is minimal. CONCLUSIONS Our results indicate that the association between depression/anxiety and cardiac autonomic dysregulation does not result from a causal pathway or genetic pleiotropy, and these traits might therefore not be inevitably linked. Previously reported associations were likely confounded by the use of certain classes of antidepressants.
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Affiliation(s)
- Mandy X. Hu
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ilja M. Nolte
- Department of Epidemiology, Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Harold Snieder
- Department of Epidemiology, Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Conor V. Dolan
- Department of Biological PsychologyVU UniversityAmsterdamThe Netherlands
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Eco J. C. de Geus
- Department of Biological PsychologyVU UniversityAmsterdamThe Netherlands
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35
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Jung W, Jang KI, Lee SH. Heart and Brain Interaction of Psychiatric Illness: A Review Focused on Heart Rate Variability, Cognitive Function, and Quantitative Electroencephalography. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:459-474. [PMID: 31671483 PMCID: PMC6852682 DOI: 10.9758/cpn.2019.17.4.459] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/30/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022]
Abstract
Heart rate variability (HRV) reflects beat-to-beat variability in the heart rate due to the dynamic interplay of the sympathetic and parasympathetic nervous systems. HRV is considered an index of the functional status of the autonomic nervous system. A decrease in HRV is thus observed in individuals with autonomic dysfunction. Abnormal HRV has been reported in a range of mental disorders. In this review, we give an overview of HRV in patients with major depressive disorder (MDD), schizophrenia, and posttraumatic stress disorder (PTSD), one of whose core symptoms is cognitive dysfunction. The association between HRV and cognitive function is highlighted in this review. This review consists of three main sections. In the first section, we examine how HRV in patients with MDD, schizophrenia, and PTSD is characterized, and how it is different when compared to that in healthy controls. In the second section, beyond the heart itself, we discuss the intimate connection between the heart and the brain, focusing on how HRV interacts with quantitative electroencephalography (qEEG) in the context of physiological changes in the sleep cycle. Lastly, we finish the review with the examination of the association between HRV and cognitive function. The overall findings indicate that the reduction in HRV is one of main manifestations in MDD, schizophrenia, and PTSD, and also more generally HRV is closely linked to the change in qEEG and also to individual differences in cognitive performance.
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Affiliation(s)
- Wookyoung Jung
- Department of Psychology, Keimyung University, Daegu, Korea
| | - Kuk-In Jang
- 2Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Korea.,Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry,Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.,Clinical Emotion and Cognition Research Laboratory, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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36
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Walter FA, Gathright E, Redle JD, Gunstad J, Hughes JW. Depressive Symptoms are Associated with Heart Rate Variability Independently of Fitness: A Cross-Sectional Study of Patients with Heart Failure. Ann Behav Med 2019; 53:955-963. [PMID: 30958884 PMCID: PMC6779069 DOI: 10.1093/abm/kaz006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression is associated with reduced heart rate variability (HRV) in healthy and cardiac samples, which may be accounted for by physical fitness. In a small sample of cardiac patients, activity and fitness levels attenuated the relationship between HRV and depression. In the current study of heart failure (HF) patients, we hypothesized that depressive symptoms and HRV would be inversely related and physical fitness would attenuate this association. PURPOSE To determine if previous associations among depressive symptoms, physical fitness, and HRV would replicate in a sample of HF patients. METHODS The sample consisted of HF patients (N = 125) aged 68.55 ± 8.92 years, 68.8% male, and 83.2% Caucasian. The study was cross-sectional and a secondary analysis of a nonrandomized clinical trial (Trial Identifier: NCT00871897). Depressive symptoms were evaluated using the Beck Depression Inventory (BDI)-II, fitness with the 2 min step test (2MST), and HRV during a 10 min resting laboratory psychophysiology protocol. The dependent variable in hierarchical linear regressions was the root mean square of successive differences. RESULTS Controlling for sex, age, β-blocker use, hypertension, and diabetes, higher BDI-II scores significantly predicted lower HRV, β = -.29, t(92) = -2.79, p < .01. Adding 2MST did not attenuate the relationship in a follow-up regression. CONCLUSION Depressive symptoms were associated with lower HRV in HF patients, independent of physical fitness. Given the prevalence of depression and suppressed HRV common among HF patients, interventions addressing depressive symptoms and other predictors of poor outcomes may be warranted.
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Affiliation(s)
- Fawn A Walter
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Emily Gathright
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Joseph D Redle
- Summa Health Systems, Cardiovascular Institute, Akron City Hospital, Akron, OH, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Abstract
BACKGROUND Major depression (MD) is a risk factor for cardiovascular disease. Reduced heart rate variability (HRV) has been observed in MD. Given the predictive value of HRV for cardiovascular health, reduced HRV might be one physiological factor that mediates this association. METHODS The purpose of this study was to provide up-to-date random-effects meta-analyses of studies which compare resting-state measures of HRV between unmedicated adults with MD and controls. Database search considered English and German literature to July 2018. RESULTS A total of 21 studies including 2250 patients and 1982 controls were extracted. Significant differences between patients and controls were found for (i) frequency domains such as HF-HRV [Hedges' g = -0.318; 95% CI (-0.388 to -0.247)], LF-HRV (Hedges' g = -0.195; 95% CI (-0.332 to -0.059)], LF/HF-HRV (Hedges' g = 0.195; 95% CI (0.086-0.303)] and VLF-HRV (Hedges' g = -0.096; 95% CI (-0.179 to -0.013)), and for (ii) time-domains such as IBI (Hedges' g = -0.163; 95% CI (-0.304 to -0.022)], RMSSD (Hedges' g = -0.462; 95% CI (-0.612 to -0.312)] and SDNN (Hedges' g = -0.266; 95% CI (-0.431 to -0.100)]. CONCLUSIONS Our findings demonstrate that all HRV-measures were lower in MD than in healthy controls and thus strengthens evidence for lower HRV as a potential cardiovascular risk factor in these patients.
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Affiliation(s)
- Celine Koch
- Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
| | - Marcel Wilhelm
- Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
| | - Stefan Salzmann
- Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
| | - Winfried Rief
- Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
| | - Frank Euteneuer
- Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Lesnewich LM, Conway FN, Buckman JF, Brush CJ, Ehmann PJ, Eddie D, Olson RL, Alderman BL, Bates ME. Associations of depression severity with heart rate and heart rate variability in young adults across normative and clinical populations. Int J Psychophysiol 2019; 142:57-65. [PMID: 31195066 DOI: 10.1016/j.ijpsycho.2019.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
Abstract
Limitations of current depression treatments may arise from a lack of knowledge about unique psychophysiological processes that contribute to depression across the full range of presentations. This study examined how individual variations in heart rate (HR) and heart rate variability (HRV) are related to depressive symptoms across normative and clinical populations in 152 young adults (aged 18-35 years). Moderating effects of sex and antidepressant medication status were considered. Electrocardiogram data were collected during "vanilla" baseline and in response to positive and negative emotional cues. Linear regressions and repeated-measures mixed models were used to assess the relationships between Beck Depression Inventory-II (BDI-II) scores, sex, antidepressant use, and cardiovascular outcomes. Baseline models yielded significant main effects of BDI-II and sex on HR and significant interactions between antidepressant medication status and BDI-II on HRV outcomes. The main effects of BDI-II and sex on HR were no longer significant after controlling for cardiorespiratory fitness. Participants who denied current antidepressant use (n = 137) exhibited a negative association and participants who endorsed current antidepressant (n = 15) use exhibited a positive association between BDI-II scores and HRV. Emotional reactivity models were largely non-significant with the exception of a significant main effect of antidepressant medication status on high-frequency HRV reactivity. Results indicated antidepressant medication use may moderate the relationship between depression severity and cardiovascular functioning, but this requires replication given the modest proportion of medicated individuals in this study. Overall, findings suggest cardiovascular processes and cardiorespiratory fitness are linked to depression symptomatology and may be important to consider in depression treatment.
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Affiliation(s)
- Laura M Lesnewich
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854, USA.
| | - Fiona N Conway
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX 78712, USA.
| | - Jennifer F Buckman
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854, USA; Department of Kinesiology and Health, Rutgers, The State University of New Jersey, 70 Lipman Drive, New Brunswick, NJ 08901, USA.
| | - Christopher J Brush
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, 70 Lipman Drive, New Brunswick, NJ 08901, USA.
| | - Peter J Ehmann
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, 70 Lipman Drive, New Brunswick, NJ 08901, USA.
| | - David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, USA.
| | - Ryan L Olson
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, 1921 Chestnut Street, Denton, TX 76203, USA.
| | - Brandon L Alderman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, 70 Lipman Drive, New Brunswick, NJ 08901, USA.
| | - Marsha E Bates
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854, USA; Department of Kinesiology and Health, Rutgers, The State University of New Jersey, 70 Lipman Drive, New Brunswick, NJ 08901, USA.
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Vloet TD, Jans T, Frey A, Häußler M, Vloet A, Geissler J, Susewind M, von Dobschütz B, Frantz S, Romanos M. Mean Heart Rate and Parameters of Heart Rate Variability in Depressive Children and the Effects of Antidepressant Medication. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:253-260. [PMID: 30971175 DOI: 10.1024/1422-4917/a000672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Researchers have repeatedly discovered an association between depression and autonomic cardiac dysregulation in adults. However, corresponding data concerning minors are still rare. Method: For this exploratory, cross-sectional study, we included N = 43 minors (age range 9-17 years). The subjects were depressive subjects with or without antidepressant medication (N = 23) or healthy control children (HC) (N = 20). We assessed several indices of cardiac functioning using long-term electrocardiogram data (mean heart rate, HR, and several parameters of heart rate variability, HRV). We hypothesized that increased HR and reduced HRV are associated with depressive disorders. Furthermore, we assessed the impact of age, sex, and antidepressant medication on HR and HRV. Results: When sex and age were controlled for, HR was significantly increased in depressive minors compared to HC. However, our preliminary data suggest that this might not be the case in medicated patients, and there were no differences between groups regarding HRV parameters. There was no significant correlation in the whole sample between severity of depression and both HR and HRV. In the subsample of patients with depression, antidepressant medication was associated with lower HR and higher indices of HRV. Conclusion: The data indicate an association between depression and altered autonomic cardiac regulation, which can already manifests in minors.
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Affiliation(s)
- Timo D Vloet
- 1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany.,a First authors
| | - Thomas Jans
- 1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany.,a First authors
| | - Anna Frey
- 2 Department of Internal Medicine I, University Hospital, Würzburg, Germany
| | - Marie Häußler
- 1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Andrea Vloet
- 1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Julia Geissler
- 1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Moritz Susewind
- 1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | | | - Stefan Frantz
- 2 Department of Internal Medicine I, University Hospital, Würzburg, Germany
| | - Marcel Romanos
- 1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
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40
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Zhao L, Yang L, Su Z, Liu C. Cardiorespiratory Coupling Analysis Based on Entropy and Cross-Entropy in Distinguishing Different Depression Stages. Front Physiol 2019; 10:359. [PMID: 30984033 PMCID: PMC6449862 DOI: 10.3389/fphys.2019.00359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
Aims This study used entropy- and cross entropy-based methods to explore the cardiorespiratory coupling of depressive patients, and thus to assess the values of those entropy methods for identifying depression patients with different disease severities. Methods Electrocardiogram (ECG) and respiration signals from 69 depression patients were recorded simultaneously for 5 min. Patients were classified into three groups according to the Hamilton Depression Rating Scale (HDRS) scores: group Non-De (HDRS 0–7), Mid-De (HDRS 8–17), and Con-De (HDRS >17). Sample entropy (SEn), fuzzy measure entropy (FMEn) and high-frequency power (HF) were computed on the original RR interval time series and breath-to-breath interval time series. Cross sample entropy (CSEn) and cross fuzzy measure entropy (CFMEn) were computed on interval time series resampled at 2 Hz and 4 Hz, respectively. The difference among three patient groups and correlation between entropy values and HDRS scores were analyzed by statistical analysis. Surrogate data were also employed to confirm the validation of entropy measures in this study. Results A consistent increasing trend has been found among most entropy measures from Non-De, to Mid-De, and to Con-De groups, and a significant (p < 0.05) difference in FMEn of RR intervals exists between Non-De and Mid-De or Con-De groups. Significant differences have been also found in all cross entropies, between Non-De and Con-De groups and between Mid-De and Con-De groups. Furthermore, significant correlations also exist between HDRS scores and FMEn of RR intervals (R = 0.24, p < 0.05), CSEn at 4 Hz (R = 0.26, p < 0.05) or 2 Hz (R = 0.28, p < 0.05) resampling, and CFMEn at 4 Hz (R = 0.31, p < 0.01) or 2 Hz (R = 0.30, p < 0.05) resampling. A significant difference of cardiorespiratory coupling parameters between different depression stages and significant correlations between entropy measures and depression severity both indicate central autonomic dysregulation in depression patients and reflect varying degrees of vagal modulation reduction among different depression levels. Analysis based on surrogate data confirms that the non-linear properties of the physiological signals played a major role in depression recognition. Conclusion The current study demonstrates the potential of cardiorespiratory coupling in the auxiliary diagnosis of depression based on the entropy method.
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Affiliation(s)
- Lulu Zhao
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Licai Yang
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Zhonghua Su
- Second Affiliated Hospital of Jining Medical College, Jining, China
| | - Chengyu Liu
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
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41
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Heart rate variability for treatment response between patients with major depressive disorder versus panic disorder: A 12-week follow-up study. J Affect Disord 2019; 246:157-165. [PMID: 30583140 DOI: 10.1016/j.jad.2018.12.048] [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] [Received: 05/10/2018] [Revised: 11/08/2018] [Accepted: 12/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart Rate Variability (HRV) parameters have been used to evaluate the autonomic nervous system. We hypothesized that patients with major depressive disorder (MDD) and panic disorder (PD) showed different HRV profiles compared to healthy controls. We also hypothesized that we could predict the responder groups in the MDD and PD patients, using differences in HRV indices between the stress and rest phases. METHODS 28 MDD patients and 29 PD patients were followed for 12 weeks, and we also followed 39 healthy control subjects. We measured HRV parameters at the rest, stress, and recovery phases. RESULTS Patients with MDD and PD demonstrated lower pNN50 than controls during the stress (F = 7.49, p = 0.001), and recovery phases (F = 9.43, p = 0.0001). Patients with MDD and PD also showed higher LF/HF ratio than controls during the stress phase (F = 6.15, p = 0.002). Responders in the PD group presented a lower level of LF/HF ratio during the stress phase compared to non-responders (F = 10.14, p = 0.002), while responders in the MDD group showed a lower level of heart rate during all three phases, compared to non-responders. Additionally, we could predict treatment response in patients with MDD using ΔLF/HF ratio (OR: 1.33, 95% CI = 1.07-1.65, p = 0.011) and ΔpNN50 (OR: 1.49, 95% CI 1.09-1.77, p = 0.014). CONCLUSION The changes of HRV parameters of pNN50 and LF/HF ratio between the stress and recovery phase may be clinical markers of predictors of treatment responsiveness in MDD and PD patients.
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Beauchaine TP, Bell Z, Knapton E, McDonough-Caplan H, Shader T, Zisner A. Respiratory sinus arrhythmia reactivity across empirically based structural dimensions of psychopathology: A meta-analysis. Psychophysiology 2019; 56:e13329. [PMID: 30672603 DOI: 10.1111/psyp.13329] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022]
Abstract
Low resting respiratory sinus arrhythmia (RSA) is observed in many mental health conditions, including anxiety disorders, mood disorders, schizophrenia spectrum disorders, disruptive behavior disorders, and nonsuicidal self-injury, among others. Findings for RSA reactivity are more mixed. We evaluate associations between RSA reactivity and empirically derived structural categories of psychopathology-including internalizing, externalizing, and thought problems-among physically healthy adults. We searched multiple electronic databases for studies of RSA among participants who were assessed either dimensionally using well-validated measures or diagnostically using structured interviews. Strict inclusion criteria were used to screen 3,605 published reports, which yielded 37 studies including 2,347 participants and 76 effect sizes. We performed a meta-analysis, with meta-analytic regressions of potential moderators, including psychopathology subtypes. The sample-wide meta-analytic association between RSA reactivity and psychopathology was quite small, but heterogeneity was considerable. Moderation analyses revealed significant RSA reactivity (withdrawal) specifically in externalizing samples. Additional moderators included (a) stimulus conditions used to elicit RSA reactivity (only negative emotion inductions were effective), (b) sex (women showed greater RSA reactivity than men), and (c) adherence to established methodological guidelines (e.g., higher electrocardiographic sampling rates yielded greater RSA reactivity). These findings indicate that associations between RSA reactivity and psychopathology are complex and suggest that future studies should include more standardized RSA assessments to increase external validity and decrease measurement error.
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Affiliation(s)
| | - Ziv Bell
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Erin Knapton
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | | | - Tiffany Shader
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Aimee Zisner
- Department of Psychology, The Ohio State University, Columbus, Ohio
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Kwon HB, Yoon H, Choi SH, Choi JW, Lee YJ, Park KS. Heart rate variability changes in major depressive disorder during sleep: Fractal index correlates with BDI score during REM sleep. Psychiatry Res 2019; 271:291-298. [PMID: 30513461 DOI: 10.1016/j.psychres.2018.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 11/10/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
We investigated the relationship between autonomic nervous system activity during each sleep stage and the severity of depressive symptoms in patients with major depressive disorder (MDD) and healthy control subjects. Thirty patients with MDD and thirty healthy control subjects matched for sex, age, and body mass index completed standard overnight polysomnography. Depression severity was assessed using the Beck Depression Inventory (BDI). Time- and frequency-domain, and fractal HRV parameters were derived from 5-min electrocardiogram segments during light sleep, deep sleep, rapid eye movement (REM) sleep, and the pre- and post-sleep wake periods. Detrended fluctuation analysis (DFA) alpha-1 values during REM sleep were significantly higher in patients with MDD than in control subjects, and a significant correlation existed between DFA alpha-1 and BDI score in all subjects. DFA alpha-1 was the strongest predictor for the BDI score, along with REM density as a covariate. This study found that compared with controls, patients with MDD show reduced complexity in heart rate during REM sleep, which may represent lower cardiovascular adaptability in these patients, and could lead to cardiac disease. Moreover, DFA alpha-1 values measured during REM sleep may be useful as an indicator for the diagnosis and monitoring of depression.
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Affiliation(s)
- Hyun Bin Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea
| | - Heenam Yoon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Republic of Korea
| | - Sang Ho Choi
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Republic of Korea
| | - Jae-Won Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul 01830, Republic of Korea
| | - Yu Jin Lee
- Department of Neuropsychiatry and the Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kwang Suk Park
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea.
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Herbsleb M, Schumann A, Lehmann L, Gabriel HHW, Bär KJ. Cardio-Respiratory Fitness and Autonomic Function in Patients with Major Depressive Disorder. Front Psychiatry 2019; 10:980. [PMID: 32116813 PMCID: PMC7011194 DOI: 10.3389/fpsyt.2019.00980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022] Open
Abstract
Patients with major depressive disorder (MDD) have an augmented risk of cardiovascular morbidity and mortality. Although a link between depression and autonomic dysfunction as well as reduced cardio-respiratory fitness (CRF) is well documented, the underlying cause is a matter of debate. Therefore, we studied the interplay between autonomic function, body composition and severity of the disease to disentangle possible physiological factors influencing the assumed lack of CRF in MDD patients. We investigated seventeen patients suffering from MDD and seventeen control subjects matched with respect to age, sex, body-mass-index, and smoking habits. A resting baseline assessment and a cardiopulmonary exercise test including a prolonged recovery period were performed to study autonomic function (i.e., heart rate responses and heart rate variability) during rest, exercise and recovery as well as CRF. Most investigated autonomic indices were significantly different at rest, during exercise as well as during recovery indicating altered autonomic modulation. Nevertheless, none of our participants was classified as chronotropically incompetent. As expected, a reduced CRF (i.e., peak oxygen uptake and peak power output, p < 0.01) was observed in patients compared to controls. In addition, a correlation of baseline heart rate and of heart rate during recovery with the ventilatory threshold 1 (p < 0.05) was found in patients only, indicating a relation to the lack of CRF. Furthermore, we observed a positive correlation of the severity of the disease with the weekly sitting time (p < 0.01) as well as a negative correlation with the activity time in the intensity domain walking (p < 0.001) and with the total score of the International Physical Activity Questionnaire (p < 0.01) for patients. This study shows that patients with MDD have altered autonomic function not only during resting conditions but also during exercise as well as recovery from exercise. Intervention studies are needed to evaluate how the described autonomic alterations can be influenced by increasing CRF due to appropriate exercise training programs.
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Affiliation(s)
- Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany.,Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Luisa Lehmann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Holger H W Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
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Schlicker S, Weisel KK, Buntrock C, Berking M, Nobis S, Lehr D, Baumeister H, Snoek FJ, Riper H, Ebert DD. Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial. J Diabetes Res 2019; 2019:2634094. [PMID: 31218230 PMCID: PMC6536948 DOI: 10.1155/2019/2634094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/11/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. METHODS Randomized controlled trial- (RCT-) based data (N = 253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES - D > 40; N = 40). RESULTS Major depressive disorder diagnosis at the baseline (p prf6 = 0.01), higher levels of depression (Beck Depression Inventory II; p prpo = 0.00; p prf6 = 0.00), and lower HbA1c (p prpo = 0.04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (d prpo = 2.17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (d prpo = 0.92; 95% CI: 0.001-1.83), with a between-group effect size of d prpo = 1.05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ 2 (2)(N = 40) = 4.44; p < 0.02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (d pr6f = 0.71; 95% CI: 0.19-1.61) but not treatment response. CONCLUSION Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.
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Affiliation(s)
- Sandra Schlicker
- Friedrich-Alexander University Erlangen-Nürnberg, Germany
- Philipps-University Marburg, Germany
| | | | | | | | | | - Dirk Lehr
- Leuphana University Lüneburg, Germany
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Vagedes J, Helmert E, Kuderer S, Müller V, Voege P, Szőke H, Valentini J, Joos S, Kohl M, Andrasik F. Effects of Footbaths with Mustard, Ginger, or Warm Water Only on Objective and Subjective Warmth Distribution in Healthy Subjects: A Randomized Controlled Trial. Complement Ther Med 2018; 41:287-294. [PMID: 30477855 DOI: 10.1016/j.ctim.2018.09.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the short-term thermogenic effects of footbaths with warm water alone (WA) versus when combined with medicinal powders. DESIGN Randomized controlled trial with cross-over. INTERVENTIONS AND OUTCOMES Seventeen healthy volunteers (mean age 22.1 years, SD = 2.4; 11 female) received three footbaths with WA or WA combined with mustard (MU) or ginger (GI) in a randomized order. Self-perceived warmth (Herdecke warmth perception questionnaire) and actual skin temperatures (thermography) were assessed before (t0), immediately after footbaths (t1), and 10 minutes later (t2). The primary outcome was perceived warmth in the feet. Secondary outcomes were warmth perception in the face, hands and overall, as well as actual skin temperature in the feet, face, and hands. RESULTS Perceived warmth at the feet (primary outcome) increased significantly (all p's < .001) for MU and GI at t1 as well as for GI at t2 when compared to t0 with high effect sizes. At t2, GI differed significantly from WA (p < .001) and MU (p = .048). With regards to the secondary measures of outcome, no significant effects were seen for perceived warmth at the face or hands. Overall warmth was significantly higher at t1 compared to t0 (p = .01). Thermography assessments of skin temperature at the feet at t1 increased after all conditions (p < .001). No effects were seen in the face. At the hands, temperature decreased at t1 (p = .02) and t2 compared to t0 (p < .001). CONCLUSION The present study provides preliminary evidence that mustard and ginger increase warmth perception at the feet more than warm water alone, with only the effects for GI enduring at the brief follow-up.
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Affiliation(s)
- J Vagedes
- University of Tuebingen, Children's Hospital, Tuebingen, Germany; ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany.
| | - E Helmert
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - S Kuderer
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - V Müller
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - P Voege
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - H Szőke
- University of Pécs, Department of CAM, Pécs, Hungary
| | - J Valentini
- University of Tuebingen, Institute of General Practice and Interprofessional Care, Tuebingen, Germany
| | - S Joos
- University of Tuebingen, Institute of General Practice and Interprofessional Care, Tuebingen, Germany
| | - M Kohl
- University Furtwangen, Institute of Precision Medicine, Villingen-Schwenningen, Germany
| | - F Andrasik
- University of Memphis, Department of Psychology, Memphis, TN, USA
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Heart rate variability alterations in late life depression: A meta-analysis. J Affect Disord 2018; 235:456-466. [PMID: 29679898 DOI: 10.1016/j.jad.2018.04.071] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 03/20/2018] [Accepted: 04/07/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE There is strong evidence for a bi-directional relationship between heart-health and depression in later life, but the physiological mechanisms underlying this relationship remain unclear. Heart rate variability is one promising factor that might help explain this relationship. We present results of a meta-analysis that considers heart rate variability alterations in older adults with depression. METHODS Literature search of Embase, PsychInfo and Medline revealed five clinical studies and six observational studies that examined the relationship between heart rate variability and depression in adults with a mean age over 60. These studies were included in this meta-analysis. RESULTS Heart rate variability was reduced among older adults with clinical depression (N = 550), relative to healthy controls (Hedges' g = -0.334, 95%CI [-0.579, -0.090], p = .007). When high-frequency and low-frequency heart rate variability were investigated separately, only low-frequency heart rate variability was significantly reduced in depressed patients (Hedges' g = -0.626, 95%CI [-1.083, -0.169], p = .007). A similar but weaker pattern of results was found in the observational studies. Most findings remained significant among unmedicated depressed older adults. LIMITATIONS Evidence of effect-size heterogeneity was found in the clinical studies, indicating the need for more well-designed research in the area. CONCLUSION Heart rate variability is reduced among older adults with depression, and this effect is not fully attributable to antidepressant medication use. Specifically, low-frequency heart rate variability may be reduced in depressed older adults. Heart rate variability warrants further attention, as it could help inform research into the prevention and treatment of depression in later life.
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Andersen EH, Lewis GF, Belger A. Aberrant parasympathetic reactivity to acute psychosocial stress in male patients with schizophrenia spectrum disorders. Psychiatry Res 2018; 265:39-47. [PMID: 29684768 PMCID: PMC5984181 DOI: 10.1016/j.psychres.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 12/31/2022]
Abstract
Autonomic dysfunction represents a core domain of the pathophysiology of schizophrenia spectrum disorders (SCZ), with aberrant physiologic arousal underlying maladaptive social and cognitive behaviors. Antagonistic parasympathetic and sympathetic systems support autonomic flexibility to appropriately regulate arousal and respond to environmental challenges, which can be modeled using physiologic measures. SCZ patients consistently show heightened basal stress, however, their parasympathetic reactivity to an acute psychosocial stressor is poorly understood. Heart period (HP-arousal), respiratory sinus arrhythmia (RSA-parasympathetic vagal activity), and their relationship were measured in SCZ patients (n = 19) and healthy controls (n = 20) at baseline and during psychosocial stress exposure. Parasympathetic vagal control of arousal, reflected in RSA-HP coupling, was assessed for the first time in SCZ. Patients demonstrated blunted physiologic reactivity (less change in heart period and respiratory sinus arrhythmia), a unique increase in respiratory sinus arrhythmia relative to baseline during recovery, and elevated arousal was associated with poor cognitive performance and greater positive symptoms. Arousal regulation was tightly controlled by parasympathetic activity in controls only, indicated by a strong association between changes in heart period and respiratory sinus arrhythmia. Results are the first to demonstrate maladaptive, inefficient parasympathetic arousal regulation (RSA-HP decoupling) in reaction to psychosocial stress in SCZ, representing an autonomic profile incompatible with appropriate social and emotional functioning.
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Affiliation(s)
- Elizabeth H Andersen
- Neuroscience Curriculum, University of North Carolina, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
| | - Gregory F Lewis
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Aysenil Belger
- Neuroscience Curriculum, University of North Carolina, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA; Brain Imaging and Analysis Center, Duke University & University of North Carolina, Durham, NC, USA
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The association between antidepressant use and orthostatic hypotension in older people: a matched cohort study. ACTA ACUST UNITED AC 2018; 12:597-604.e1. [PMID: 29937420 DOI: 10.1016/j.jash.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Abstract
Orthostatic hypotension (OH) is often reported as a significant potential adverse effect of antidepressant use but the association between phasic blood pressure (BP) and antidepressants has not yet been investigated. This cross-sectional study compares continuously measured phasic BP and prevalence of OH in a cohort of antidepressant users ≥50 years compared with an age- and sex-matched cohort not taking antidepressants. OH was defined as a drop in systolic BP ≥ 20 mm Hg or in diastolic BP ≥ 10 mm Hg at 30 seconds after standing, measured using continuous beat-to-beat finometry. Multilevel time × group interactions revealed significantly greater systolic and diastolic BP drop in antidepressant users than nonusers at 30 seconds after stand. The prevalence of OH among antidepressant users was 31% (63/206), compared with 17% in nonusers (X2 = 9.7; P = .002). Unadjusted logistic regression models demonstrated that selective serotonin reuptake inhibitor use was associated with OH at an odds ratio of 2.11 (95% confidence interval: 1.25-3.57); P = .005, and this association was not attenuated when covariates including cardiac disease and depressive symptom burden were added. There was no statistically significant association between serotonin noradrenaline reuptake inhibitor or tricyclic antidepressant use and OH in unadjusted models although the study was not powered to detect changes within these subgroups. Older people taking antidepressants have a two-fold higher prevalence of OH than nonusers, highlighting the importance of screening the older antidepressant user for OH and dizziness and rationalizing medications to reduce the risk of falls within this vulnerable cohort.
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Manolis TA, Manolis AA, Manolis AS. Cardiovascular Safety of Psychiatric Agents: A Cautionary Tale. Angiology 2018; 70:103-129. [PMID: 29874922 DOI: 10.1177/0003319718780145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Psychiatric agents are among the most commonly prescribed medications. Despite the advent of newer generation agents, patients receiving them still experience cardiovascular (CV) side effects. However, these agents may have heterogeneous properties, calling for an individualized approach based on efficacy and also on the particular side effect profile of each specific agent. Proarrhythmic effects arising from drug-induced long-QT syndrome and consequent potentially life-threatening polymorphic ventricular arrhythmias in the form of torsade de pointes, the metabolic syndrome contributing to atherosclerosis and acute coronary syndromes, and drug-induced orthostatic hypotension raise major concerns. Of course, it is also crucial that fear of potential CV adverse effects does not deprive psychiatric patients of appropriate drug therapy. Modification of CV risk factors in psychiatric patients together with optimal management of their CV diseases and appropriate selection of psychotropic agents with greater efficacy and least CV toxicity are of paramount importance in mitigating CV risks and enhancing safety. Identifying patients at high risk of CV complications and close monitoring of all patients receiving these agents are crucial steps to prevent and manage such complications. All these issues are herein reviewed, relevant guidelines are discussed, and schemas are depicted that illustrate the interrelated connections among the psychotropic agents and their CV effects.
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Affiliation(s)
| | | | - Antonis S Manolis
- 3 Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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