Altered cardiovascular adaptability in depressed patients without heart disease

Bidirectionality of LF when the movie makes you sad: Effects of negative emotions on heart rate variability among patients with major depression

OBJECTIVES

Heart rate variability (HRV) reflects the capacity to adapt to internal and environmental changes. Decreased HRV may indicate inadequate adaptive capacity. This study aims to investigate the relationship between the heart and brain's adaptive abilities, both at rest and when negative emotions are stimulated in depression.

SUBJECTS AND METHODS

The study included 30 patients (20 female, 10 male) with major depression (mean age = 29.8 ± 7.8) and 30 healthy controls, all of whom had similar characteristics in terms of age and gender, selected through convenience sampling. The patients were drug-free at the time of the assessment. Holter recordings were obtained while subjects watched videos stimulating anger, fear, sadness, and a neutral video, and at rest, HRV parameters were calculated. To control for interindividual variability and account for paired sampling, linear mixed effects models were employed.

RESULTS

Watching the 'sadness video' led to an increase in low frequency band (LF) [LF change (Control vs depression); Difference:-620.80 df:107 t:-2.093 P:0.039] and LF/high frequency band ratio (LF/HF) [LF/HF change (control vs depression group); Difference:-1.718 df:105 t:-2.374 P:0.020] in the depression group. The video led to a decrease in LF and LF/HF in the controls. Although the differences between the conditions and interactions with the group were significant, the effects were independent of depression severity.

CONCLUSION

In depression, brain's regulatory effect on the heart differed from controls in the sadness condition, possibly due to increased arousal levels in subjects with depression and their inability to suppress sympathetic activity when a state of sadness is stimulated.

Enhanced polygenic risk score incorporating gene-environment interaction suggests the association of major depressive disorder with cardiac and lung function

BACKGROUND

Depression has been linked to an increased risk of cardiovascular and respiratory diseases; however, its impact on cardiac and lung function remains unclear, especially when accounting for potential gene-environment interactions.

METHODS

We developed a novel polygenic and gene-environment interaction risk score (PGIRS) integrating the major genetic effect and gene-environment interaction effect of depression-associated loci. The single nucleotide polymorphisms (SNPs) demonstrating major genetic effect or environmental interaction effect were obtained from genome-wide SNP association and SNP-environment interaction analyses of depression. We then calculated the depression PGIRS for non-depressed individuals, using smoking and alcohol consumption as environmental factors. Using linear regression analysis, we assessed the associations of PGIRS and conventional polygenic risk score (PRS) with lung function (N = 42 886) and cardiac function (N = 1791) in the subjects with or without exposing to smoking and alcohol drinking.

RESULTS

We detected significant associations of depression PGIRS with cardiac and lung function, contrary to conventional depression PRS. Among smokers, forced vital capacity exhibited a negative association with PGIRS (β = -0.037, FDR = 1.00 × 10-8), contrasting with no significant association with PRS (β = -0.002, FDR = 0.943). In drinkers, we observed a positive association between cardiac index with PGIRS (β = 0.088, FDR = 0.010), whereas no such association was found with PRS (β = 0.040, FDR = 0.265). Notably, in individuals who both smoked and drank, forced expiratory volume in 1-second demonstrated a negative association with PGIRS (β = -0.042, FDR = 6.30 × 10-9), but not with PRS (β = -0.003, FDR = 0.857).

CONCLUSIONS

Our findings underscore the profound impact of depression on cardiac and lung function, highlighting the enhanced efficacy of considering gene-environment interactions in PRS-based studies.

Cardiovascular variations in patients with major depressive disorder versus bipolar disorder

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.

Evaluating heart rate variability with 10 second multichannel electrocardiograms in a large population-based sample

Introduction

Heart rate variability (HRV), defined as the variability of consecutive heart beats, is an important biomarker for dysregulations of the autonomic nervous system (ANS) and is associated with the development, course, and outcome of a variety of mental and physical health problems. While guidelines recommend using 5 min electrocardiograms (ECG), recent studies showed that 10 s might be sufficient for deriving vagal-mediated HRV. However, the validity and applicability of this approach for risk prediction in epidemiological studies is currently unclear to be used.

Methods

This study evaluates vagal-mediated HRV with ultra-short HRV (usHRV) based on 10 s multichannel ECG recordings of N = 4,245 and N = 2,392 participants of the Study of Health in Pomerania (SHIP) from two waves of the SHIP-TREND cohort, additionally divided into a healthy and health-impaired subgroup. Association of usHRV with HRV derived from long-term ECG recordings (polysomnography: 5 min before falling asleep [N = 1,041]; orthostatic testing: 5 min of rest before probing an orthostatic reaction [N = 1,676]) and their validity with respect to demographic variables and depressive symptoms were investigated.

Results

High correlations (r = .52-.75) were revealed between usHRV and HRV. While controlling for covariates, usHRV was the strongest predictor for HRV. Furthermore, the associations of usHRV and HRV with age, sex, obesity, and depressive symptoms were similar.

Conclusion

This study provides evidence that usHRV derived from 10 s ECG might function as a proxy of vagal-mediated HRV with similar characteristics. This allows the investigation of ANS dysregulation with ECGs that are routinely performed in epidemiological studies to identify protective and risk factors for various mental and physical health problems.

Cardiac autonomic functioning and clinical outcome in adolescent borderline personality disorder over two years

The present study aimed to expand on previous findings that pre-treatment autonomic nervous system (ANS) functioning serves as a predictor of clinical outcome in adolescent borderline personality disorder (BPD), while examining whether the relationship between ANS functioning and treatment outcome may vary as a function of early life maltreatment (ELM). ANS stress response was examined considering changes in heart rate (HR) and vagally-mediated heart rate variability (vmHRV) over different conditions of the Montreal Imaging Stress Task (MIST) in a clinical sample of N = 27 adolescents across the spectrum of BPD severity. Participants received in- and/or outpatient treatment, while clinical data was assessed at routine follow-ups. Clinical outcome was defined by change in the number of fulfilled BPD criteria (as measured using the SCID-II), severity of psychopathology (CGI-S), and global level of functioning (GAF), measured 12 and 24 months after baseline assessments. Mixed-effects (random-intercept/random slope) linear regression models were calculated to examine markers of ANS function as potential predictors of clinical outcome. Irrespective of the presence of ELM exposure, both vmHRV resting-state and stress recovery measures were identified as significant predictors of clinical outcome over time. This study adds to the existing literature by replicating and expanding on preliminary findings, considering also physiological reactivity and recovery in addition to resting-state measures of ANS functioning. The present results further highlight the potential of markers of ANS functioning to serve as objective measures in the process of monitoring patient progress and to make predictions regarding treatment outcome in psychiatry research.

Brain structure and parasympathetic function during rest and stress in young adult women

Heart rate variability (HRV) is an important biomarker for parasympathetic function and future health outcomes. The present study examined how the structure of regions in a neural network thought to maintain top-down control of parasympathetic function is associated with HRV during both rest and social stress. Participants were 127 young women (90 Black American), who completed a structural MRI scan and the Trier Social Stress Test (TSST), during which heart rate was recorded. Regression analyses were used to evaluate associations between cortical thickness in five regions of the Central Autonomic Network (CAN; anterior midcingulate cortex [aMCC], pregenual and subgenual anterior cingulate cortex [pgACC, sgACC], orbitofrontal cortex [OFC], and anterior insula) and high-frequency HRV during rest and stress. Results indicated that cortical thickness in CAN regions did not predict average HRV during rest or stress. Greater cortical thickness in the right pgACC was associated with greater peak HRV reactivity during the TSST, and survived correction for multiple comparisons, but not sensitivity analyses with outliers removed. The positive association between cortical thickness in the pgACC and peak HRV reactivity is consistent with the direction of previous findings from studies that examined tonic HRV in adolescents, but inconsistent with findings in adults, which suggests a possible neurodevelopmental shift in the relation between brain structure and autonomic function with age. Future research on age-related changes in brain structure and autonomic function would allow a more thorough understanding of how brain structure may contribute to parasympathetic function across neurodevelopment.

Cardiovascular Variability and Reactivity in Major Depressive Disorder

Abstract. This study investigated cardiovascular variability and stress reactivity in major depressive disorder (MDD). While previous research has documented reduced heart rate variability, knowledge about blood pressure variability in MDD remains scarce. Regarding reactivity, a particular focus was placed on the time courses of the cardiovascular responses, which may provide insight into the autonomic mechanisms underlying the hypo-reactivity expected in MDD. In 76 MDD patients and 71 healthy controls, blood pressure was continuously recorded at rest and during mental stress induced by a 3-min serial subtraction task. Compared to controls, patients exhibited lower systolic and diastolic blood pressure, heart rate variability, and systolic and diastolic blood pressure variability. Moreover, smaller stress-related changes in heart rate, systolic and diastolic blood pressure, and sensitivity of the cardiac baroreflex arose in patients. Cardiovascular parameters did not differ between patients using antidepressants and unmedicated patients. According to time-course analysis, reduced hemodynamic modulations in MDD mainly occurred after 50 s of the stress period. Low heart rate variability in MDD reflects deficient top-down integration of the brain mechanisms allowing flexible autonomic and behavioral control; diminished blood pressure variability is indicative of poor homeostatic capacity with respect to the regulation of blood pressure and organ perfusion. Moreover, blunted cardiovascular reactivity implies poor adjustment of energetic resources to internal and environmental demands and may be a correlate of deficient motivational dynamics characterizing MDD. While cardiovascular hypo-reactivity in MDD may be mediated by baroreflex and adrenergic mechanisms, the fast-acting parasympathetic system may play a subordinate role.

Effects of Life Events and Social Isolation on Stroke and Coronary Heart Disease

The current coronavirus disease 2019 (COVID-19) pandemic represents a severe, life-changing event for people across the world. Life changes may involve job loss, income reduction due to furlough, death of a beloved one, or social stress due to life habit changes. Many people suffer from social isolation due to lockdown or physical distancing, especially those living alone and without family. This article reviews the association of life events and social isolation with cardiovascular disease, assembling the current state of knowledge for stroke and coronary heart disease. Possible mechanisms underlying the links between life events, social isolation, and cardiovascular disease are outlined. Furthermore, groups with increased vulnerability for cardiovascular disease following life events and social isolation are identified, and clinical implications of results are presented.

Features of autonomic cardiovascular control during cognition in major depressive disorder

Previous research has suggested reduced parasympathetic cardiac regulation during cognitive activity in major depressive disorder (MDD). However, little is known about possible abnormalities in sympathetic control and cardiovascular reactivity. This study aimed to provide a comprehensive analysis of autonomic cardiovascular control in the context of executive functions in MDD. Thirty six MDD patients and 39 healthy controls participated. Parameters of sympathetic (pre-ejection period, PEP) and parasympathetic control (high and low frequency heart rate variability, HF HRV, LF HRV; and baroreflex sensitivity, BRS) as well as RR interval were obtained at rest and during performance of executive function tasks (number-letter task, n-back task, continuous performance test, and Stroop task). Patients, as compared to controls, exhibited lower HF HRV and LF HRV during task execution and smaller shortenings in PEP and RR interval between baseline and tasks. They displayed longer reaction times during all conditions of the tasks and more omission errors and false alarms on the continuous performance test. In the total sample, on-task HF HRV, LF HRV and BRS, and reactivity in HF HRV, LF HRV, and PEP, were positively associated with task performance. As performance reduction arose independent of executive function load of the tasks, the behavioral results reflect impairments in attention and processing speed rather than executive dysfunctions in MDD. Abnormalities in cardiovascular control during cognition in MDD appear to involve both divisions of the autonomic nervous system. Low tonic parasympathetic control and blunted sympathetic reactivity imply reduced physiological adjustment resources and, by extension, provide suboptimal conditions for cognitive performance.

Examining reactivity patterns in burnout and other indicators of chronic stress

INTRODUCTION

Burnout symptomatology is associated with various negative health consequences; however, the mechanisms underlying these associations remain unclear. One potential pathway involves alterations in the acute stress response. The aims of the present study were to examine burnout-associated alterations in stress-reactivity patterns, during a standardized social stressor compared to a control condition, as well as to examine whether effects associated with greater burnout symptomatology were distinct from other, conceptually overlapping indicators of chronic stress (i.e. depressive symptomatology and elevated hair cortisol concentration [HCC]).

MATERIALS AND METHODS

In a randomized two-factor design a total of 70 employed males with varying burnout symptoms but without evidence of physical or psychiatric disease were exposed to the Trier Social Stress Test for Groups (TSST-G) or a non-stressful control condition. Acute stress reactivity was assessed using self-report stress measures and non-invasive biomarkers. Associations among acute stress reactivity, burnout and depressive symptoms (assessed with self-report measures), as well as HCC were analysed using repeated measure ANCOVAs and moderation analysis.

RESULTS

Burnout symptomatology was associated with elevated stress perception independent of the experimental condition. In addition, depressive symptomatology was associated with enhanced anticipatory appraisal, whereas HCC was not related to any subjective stress measure. On a physiological level, burnout and depressive symptomatology, as well as HCC were associated with a pattern of blunted cardiovascular reactivity, however the timing of this effect varied.

CONCLUSION

Our results indicate burnout-associated modulations in stress reactivity, which diverge, at least partly, from other indicators of chronic stress.

Heart rate variability related to season of birth: A replication study

Low heart rate variability (HRV) has strongly been associated with an increased risk for cardiovascular disease. With cardiovascular disease being the number one cause of global deaths, factors that influence its development are relevant to understand. Season of birth has been suggested as one of the factors influencing the development of HRV. The current study was set up to replicate the finding that men born in winter have higher HRV later in life compared to those born in other seasons. To this end, we studied a sample of 1,871 healthy participants from the Brain Resource International Database during rest and during task. Furthermore, sex and age differences and associations with personality traits and psychiatric symptoms were explored. We replicated the earlier finding that men born in winter have a lower ratio of low frequency (LF) power to high frequency (HF) power during rest compared to summer and fall, and, although less pronounced, higher HF compared to summer. A difference between summer and winter for LF/HF in men was internally replicated using data recorded during task. Additionally, for both sexes, LF/HF ratio increased with age, and LF and HF both decreased. In general, LF/HF was lower in women, but heart rate was higher. In men, low HRV was associated with depression and the personality trait openness. In conclusion, results from a large multicenter data set covering the entire lifespan demonstrate that HRV changes with age in both sexes and confirm that season of birth influences HRV later in life in men.

This is a replication study, showing heart rate variability (HRV) to vary with season of birth (SoB). Since both HRV and SoB have been related to cardiovascular disease, the relationship is relevant to understand. We used an almost five times larger sample than the original sample, covering wider geographic areas and the full lifespan. Additionally, age and sex differences in HRV were found. Replicating earlier findings provides solid evidence for a relationship between SoB and HRV later in life, thereby providing insights on how HRV develops and ultimately how increased risk for cardiovascular disease can be reduced.

Associations of depression severity with heart rate and heart rate variability in young adults across normative and clinical populations

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.

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

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

History of Preeclampsia Adds to the Deleterious Effect of Chronic Stress on the Cardiac Ability to Flexibly Adapt to Challenge

Preeclampsia, a pregnancy-specific disorder, presents a major health problem during gestation, but is also associated with increased risk for cardiovascular complications in later life. We aimed to investigate whether chronic stress experience and preeclampsia may have additive adverse effects on the cardiac ability to flexibly adapt to challenge, that is, to mount an appropriately vigorous heart rate response to an acute psychological challenge, or whether they may perhaps have synergistic effects (e.g., mutual augmentation of effects). Blunted cardiac responding to challenge has been linked to poor health outcomes in the longer term. Women previously affected by preeclampsia and women after uncomplicated pregnancies were tested 15-17 weeks post-partum in a standardized stress-reactivity protocol, while cardiovascular variables were simultaneously recorded. Changes in heart rate and blood pressure in response to the stressor were analyzed with regard to the effects of history of preeclampsia and chronic stress experience. Findings indicated blunted cardiac responses in women with higher chronic stress experience (p = 0.020) and, independently from that, in women with a history of preeclampsia (p = 0.018), pointing to an additive nature of the effects of preeclampsia and chronic stress on impaired cardiovascular functioning. Consequently, if both are present, a history of preeclampsia may add to the already deleterious effects of the experience of chronic stress. The additive nature of the effects suggests that stress-reducing interventions, albeit they will not eliminate the heightened cardiovascular risk in patients with a history of preeclampsia, may improve their overall prognosis by avoiding further accumulation of risk.

Impact of metoprolol treatment on cardiac function and exercise tolerance in heart failure patients with neuropsychiatric disorders

OBJECTIVE

To investigate the impact of neuropsychiatric disorders on the effect of metoprolol on cardiac and motor function in chronic heart failure (CHF) patients.

METHODS

From February 2013 to April 2016, CHF patients with clinical mental disorders received metoprolol (23.75 or 47.5 mg, once daily, orally) at the Second Affiliated Hospital of Kunming Medical University. Mental status was confirmed by means of the Hospital Anxiety and Depression Scale (HADS) and the Copenhagen Burnout Inventory (CBI) scale. Cardiac function parameters such as systolic blood pressure (SBP), ejection fraction (EF) and cardiac index (CI) as well as motor function including the 6 meter walk test (6MWT) and the Veteran's Specific Activity Questionnaire (VSAQ) were assessed as primary outcomes of the study.

RESULTS

A total of 154 patients (median age, 66.39 years; men, n = 101) were allocated into eight groups based on their mental status. There were no significant differences in heart rate (HR) or SBP control achieved by metoprolol in any groups compared with the control (patients with normal mental status). Furthermore, biphasic ejection fraction (EF) changes were observed in all the groups with a decrease in the first month and increase from the sixth month. However, this increase was significantly lower (p < .001) than the EF achieved with metoprolol treatment in the control group except for the anxiety group. A similar pattern was seen for CI, 6MWT and VSAQ changes in all the groups. Patients in the anxiety group responded similarly to the patients with normal mental status.

CONCLUSION

Depressive and high burnout symptoms, but not anxiety, lower the improvement of cardiac and motor function by metoprolol treatment in CHF.

Attachment-Related Regulatory Processes Moderate the Impact of Adverse Childhood Experiences on Stress Reaction in Borderline Personality Disorder

In this study, the authors explored whether attachment insecurity moderates the effects of adverse childhood experiences on stress reactivity in the context of borderline personality disorder (BPD). Participants were 113 women (39 with BPD, 15 with some BPD criteria present, 59 without any BPD symptoms) who participated in the Trier Social Stress Test. Saliva samples were collected before and after the stressor and assayed for salivary alpha-amylase (sAA) and cortisol. Adverse childhood experiences were measured using the Childhood Trauma Questionnaire, and attachment by the Experiences in Close Relationships-Revised questionnaire. Results revealed that attachment avoidance and a combination of more adverse childhood experiences and attachment insecurity resulted in higher sAA levels and differences in reactivity to the stressor. Interactions between attachment anxiety and adverse childhood experiences were related to blunted cortisol reactivity. The results suggest that the influence of adverse childhood experiences on stress regulation in BPD may be moderated by attachment-related regulatory processes.

Number of recent stressful life events and incident cardiovascular disease: Moderation by lifetime depressive disorder

OBJECTIVE

We investigated whether number of recent stressful life events is associated with incident cardiovascular disease (CVD) and whether this relationship is stronger in adults with a history of clinical depression.

METHODS

Prospective data from 28,583 U.S. adults (mean age=45years) initially free of CVD who participated in Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Number of past-year stressful life events (Wave 1), lifetime depressive disorder (Wave 1), and incident CVD (Wave 2) were determined by structured interviews.

RESULTS

There were 1069 cases of incident CVD. Each additional stressful life event was associated with a 15% increased odds of incident CVD [Odds Ratio (OR)=1.15, 95% Confidence Interval (CI): 1.11, 1.19]. As hypothesized, a stressful life events by lifetime depressive disorder interaction was detected (P=0.003). Stratified analyses indicated that stressful life events had a stronger association with incident CVD among adults with (OR=1.18, 95% CI: 1.10, 1.27, n=4908) versus without (OR=1.10, 95% CI: 1.07, 1.14, n=23,675) a lifetime depressive disorder.

CONCLUSION

Our findings suggest that a greater number of recent stressful life events elevate the risk of new-onset CVD and that this risk is potentiated in adults with a history of clinical depression.

Symptoms of anxiety and depression are related to cardiovascular responses to active, but not passive, coping tasks

Objective:

Anxiety and depression have been linked to blunted blood pressure (BP) and heart rate (HR) reactions to mental stress tests; however, most studies have not included indices of underlying hemodynamics nor multiple stress tasks. This study sought to examine the relationships of anxiety and depression with hemodynamic responses to acute active and passive coping tasks.

Methods:

A total of 104 participants completed the Hospital Anxiety and Depression Scales and mental arithmetic, speech, and cold pressor tasks while BP, HR, total peripheral resistance, and cardiac output (CO) were assessed.

Results:

After adjustment for traditional risk factors and baseline cardiovascular activity, depression scores were negatively associated with systolic BP, HR, and CO responses to the mental arithmetic task, while anxiety scores were inversely related to the systolic BP response to mental arithmetic.

Conclusion:

High anxiety or depression scores appear to be associated with blunted cardiac reactions to mental arithmetic (an active coping task), but not to the cold pressor test or speech tasks. Future research should further examine potential mechanisms and longitudinal pathways relating depression and anxiety to cardiovascular reactivity.

Clinical trial registration number:

TCTR20160208004

Atypical reactivity of heart rate variability to stress and depression across development: Systematic review of the literature and directions for future research

Heart rate variability has received growing attention in the depression literature, with several recent meta-analyses indicating that lower resting heart rate variability is associated with depression. However, the role of fluctuations in heart rate variability (or reactivity) in response to stress in depression remains less clear. The present review provides a systematic examination of the literature on heart rate variability reactivity to a laboratory-induced stressor task and depression, including 26 studies of reactivity in heart rate variability and clinical depression, remitted (or history of) depression, and subthreshold depression (or symptom-level depression) among adults, adolescents, and children. In addition to reviewing the findings of these studies, methodological considerations and conceptual gaps in the literature are addressed. We conclude by highlighting the importance of investigating the potential transactional relationship between heart rate variability reactivity and depression and possible mechanisms underlying this relationship.

Investigation of heart rate variability in major depression patients using wavelet packet transform

Studies conducted in major depression (MD) patients have reported a high risk of cardiac morbidity as a result of the relationship between changed cardiovascular activity (CA) and autonomic dysfunctions. The investigation of heart rate variability (HRV) gives valuable idea about variances in autonomic CA of MD patients. To get this knowledge, frequency-domain HRV analysis is frequently performed using Fourier transformation (FT) or discrete-wavelet transformation (DWT) to decompose the data into high-frequency (HF) and low-frequency (LF) bands. Nevertheless, it has been reported that the FT is not useful for nonstationary HRV signals and the DWT does not ensure required frequency boundaries of each band. This study aims to compare the frequency-domain HRV features using wavelet-packet-transform (WPT) with absolutely excellent approximation to required band ranges between the controls and patients. In addition to LF and HF band energies, sympathovagal balance that indicates the variation of sympathetic and parasympathetic activities were compared between two groups. Patients had a significantly lower HF energy, higher values of LF energy and higher LF/HF ratio. Our results recommend that impairments in coordination between parasympathetic and sympathetic behavior in MD patients can be assessed by HRV analysis using WPT with high resolution decomposition for needed bands.

Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

BACKGROUND

Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use.

METHODS

We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication.

RESULTS

In total, 140 case-control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = -0.583) with a large effect for psychotic disorders (Hedges g = -0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics.

LIMITATIONS

Study quality significantly moderated effect sizes in case-control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings.

CONCLUSION

Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.

Role of peripheral vascular resistance for the association between major depression and cardiovascular disease

Major depression and cardiovascular diseases are 2 of the most prevalent health problems in Western society, and an association between them is generally accepted. Although the specific mechanism behind this comorbidity remains to be elucidated, it is clear that it has a complex multifactorial character including a number of neuronal, humoral, immune, and circulatory pathways. Depression-associated cardiovascular abnormalities associate with cardiac dysfunctions and with changes in peripheral resistance. Although cardiac dysfunction in association with depression has been studied in detail, little attention was given to structural and functional changes in resistance arteries responsible for blood pressure control and tissue perfusion. This review discusses recent achievements in studies of depression-associated abnormalities in resistance arteries in humans and animal experimental models. The changes in arterial structure, contractile and relaxing functions associated with depression symptoms are discussed, and the role of these abnormalities for the pathology of major depression and cardiovascular diseases are suggested.

How are neuroticism and depression related to the psychophysiological stress response to acute stress in healthy older people?

Neuroticism and depressive symptomatology have been related to a heightened and diminished physiological stress response, which may partly explain their negative relationship with health and wellbeing. Identifying factors that may increase disease vulnerability is especially relevant in older people, whose physiological systems decline. With this in mind, we investigated the influence of neuroticism and depression on the psychophysiological stress response in healthy older people (from 55 to 76years old). A total of 36 volunteers were exposed to a stressful task (Trier Social Stress Test, TSST), while 35 volunteers performed a control non-stressful task. The physiological stress response was assessed through measures of cortisol, alpha-amylase, heart rate (HR). Our results showed that, neuroticism was not related to physiological stress response. However, depression was related to higher cortisol response and lower HR reactivity in the stress condition. In summary, emotional states such as depressive mood seem to amplify the cortisol stress response and reduce the cardiovascular response, whereas more stable dispositions such as neuroticism did not affect stress response in older people. These findings confirm, in healthy older people, the adverse effects of depression, acting on different subsystems of the stress response.

Analysis of sympathovagal balance in patients with major depressive disorder using wavelet packet transform

Elevated rates of cardiac morbidity have been frequently reported in major depressive disorder (MDD) patients as a result of the relationship between autonomic dysfunctions and varied cardiovascular activity. Heart rate variability (HRV) analysis is an important and non-invasive way for assessing the variances in autonomic nervous system activity of MDD patients. In spectral domain, HRV analysis is usually done by either Fourier transformation (FT) or discrete wavelet transformation (DWT) to divide the data into lowfrequency (LF) and high-frequency (HF) bands. However, while FT is not a proper method for non-stationary HRV data, DWT does not exactly produce required frequency ranges of each LF and HF bands. The purpose of the present study is to investigate the spectral HRV measures obtained by wavelet packet transform (WPT) with absolutely excellent approximation to predefined frequency ranges of bands. Eighteen healthy controls and age- and gender-match eighteen patients with MDD were participated in this study. Sympathovagal balance (LF/HF ratio) that reflects the variation of sympathetic and parasympathetic activities was compared between two groups. Individuals with depression had a significantly higher LF/HF ratio. Our findings suggest that dysfunctions in coordination between sympathetic and parasympathetic nervous system activity in MDD patients can be evaluated by WPT based HRV analysis with high resolution decomposition for required LF and HF bands.

Comparative Study of Heart Rate Variability in Patients with Schizophrenia, Bipolar Disorder, Post-traumatic Stress Disorder, or Major Depressive Disorder

Objective

Heart rate variability (HRV) changes as a function of psychiatric illness. This study aimed to evaluate HRV among patients with various psychiatric disorders.

Methods

The present study recruited patients with schizophrenia (n=35), bipolar disorder (n=41), post-traumatic stress disorder (PTSD; n=34), or major depressive disorder (n=34) as well as healthy controls (n=27). The time-domain analysis (the standard deviation of all RR intervals [SDNN] and the square root of the mean squared differences of successive normal sinus intervals [RMSSD]), the frequency-domain analysis (very low frequency, low frequency [LF], high frequency [HF], and total power [TP]), and a non-linear complexity measure the approximate entropy were computed.

Results

SDNN and HF were significantly reduced in patients with schizophrenia compared with healthy controls. SDNN, RMSSD, TP, LF, and HF were significantly reduced in bipolar patients compared with healthy controls. HF was significantly reduced in PTSD patients compared with healthy controls.

Conclusion

Our findings indicate that HRV is not sufficiently powerful to discriminate among various psychiatric illnesses. However, our results suggest that HRV, particularly HF, could be used as a tool for discriminating between psychiatric patients and healthy controls.

Cardiovascular response to psychosocial repeated stress in caregivers of offspring with schizophrenia

Taking care of offspring suffering a long-term illness such as schizophrenia is one of the more stressful life experiences. Care conditions may act as a protective factor in the health of the caregiver. The present study assesses heart rate (HR), blood pressure (BP), and mood responses to psychosocial stress in 16 mothers receiving specialised support for the care of their offspring (CARE+) and in 11 mothers caring for their offspring without support (CARE-). The CARE- group take care of less functional and more symptomatic offspring; and display higher basal, but lower HR, responses after stress than the CARE+ group. No significant group effects were found for BP. For mood states, there were significant decreases in the anger subscale in the CARE- group that were not found in the CARE+ group. HR was related to active and passive coping styles, trait anxiety, and years spent providing care. In the total sample, other significant relationships between cardiovascular responses and life events and personality traits have been found. In sum, the data suggests that specialised support for patients may modulate cardiovascular responses to repeated stress in caregivers.

Altered cardiac autonomic nervous function in depression

BACKGROUND

Depression is an independent risk factor for coronary artery disease. Autonomic instability may play a mediating or moderating role in this relationship; however this is not well understood. The objective of this study was to explore cardiac autonomic function and cardiac arrhythmia in depression, the correlation between depression severity and Heart Rate Variability (HRV) related indices, and the prevalence of arrhythmia.

METHODS

Individuals (n = 53) with major depression as assessed by the Diagnostic and Statistical Manual of Mental Disorders, who had a Hamilton Rating Scale for Depression (HAMD) score ≥20 and a Zung Self-Rating Depression Scale score > 53 were compared to 53 healthy individuals, matched for age and gender. Multichannel Electrocardiograph ECG-92C data were collected over 24 hours. Long-term changes in HRV were used to assess the following vagally mediated changes in autonomic tone, expressed as time domain indices: Standard deviation of the NN intervals (SDNN), standard deviation of 5 min averaged NN intervals (SDANN), Root Mean Square of the Successive Differences (RMSSD) and percentage of NN intervals > 50 ms different from preceding interval (pNN50). Pearson's correlations were conducted to explore the strength of the association between depression severity (using the SDS and HRV related indices, specifically SDNN and low frequency domain / high frequency domain (LF/HF)).

RESULTS

The values of SDNN, SDANN, RMSSD, PNN50 and HF were lower in the depression group compared to the control group (P<.05). The mean value of the LF in the depression group was higher than the in control group (P<.05). Furthermore the ratio of LF/HF was higher among the depression group than the control group (P<.05). A linear relationship was shown to exist between the severity of the depression and HRV indices. In the depression group, the prevalence of arrhythmia was significantly higher than in the control group (P<.05), particularly supraventricular arrhythmias.

CONCLUSIONS

Our findings suggest that depression is accompanied by dysfunction of the cardiac autonomic nervous system, and further, that depression severity is linked to severity of this dysfunction. Individuals with depression appear to be susceptible to premature atrial and/or ventricular disease.

A new theoretical approach to the functional meaning of sleep and dreaming in humans based on the maintenance of 'predictive psychic homeostasis'

Different theories have been put forward during the last decade to explain the functional meaning of sleep and dreaming in humans. In the present paper, a new theory is presented which, while taking advantage of these earlier theories, introduces the following new and original aspects:   • Circadian rhythms relevant to various organs of the body affect the reciprocal interactions which operate to maintain constancy of the internal milieu and thereby also affect the sleep/wakefulness cycle. Particular attention is given to the constancy of natraemia and osmolarity and to the permissive role that the evolution of renal function has had for the evolution of the central nervous system and its integrative actions. • The resetting of neuro-endocrine controls at the onset of wakefulness leads to the acquisition of new information and its integration within previously stored memories. This point is dealt with in relation to Moore-Ede's proposal for the existence of a 'predictive homeostasis'. • The concept of 'psychic homeostasis' is introduced and is considered as one of the most important states since it is aimed at the well-being, or eudemonia, of the human psyche. Sleep and dreaming in humans are discussed as important functions for the maintenance of a newly proposed composite state: that of 'predictive psychic homeostasis'. On the basis of these assumptions, and in accordance with the available neurobiological data, the present paper puts forward the novel hypothesis that sleep and dreaming play important functions in humans by compensating for psychic allostatic overloads. Hence, both consolatory dreams and disturbing nightmares can be part of the vis medicatrix naturae, the natural healing power, in this case, the state of eudemonia.

Patterns of cardiorespiratory coordination in young women with recurrent major depressive disorder treated with escitalopram or venlafaxine

Evidence from previous studies suggests autonomic dysregulation in patients with major depressive disorder (MDD). Antidepressant treatment may also affect central autonomic function. We investigated whether the type of antidepressant might be associated with the pattern of cardiorespiratory coordination in non-depressed women with recurrent MDD. Resting electrocardiograms and respiratory signals were simultaneously recorded from 38 euthymic women with recurrent MDD who were treated with either escitalopram (n=19) or venlafaxine (n=19) monotherapy and from 38 healthy women. Linear measures of heart rate variability were extracted to assess cardiac autonomic control. Sample entropy (SampEn) was computed to assess the complexity of heart rate and respiratory signals, and cross-SampEn was calculated to measure the nonlinear interaction of both signals. Significant decreases in the cardiovagal tone and cardiorespiratory coupling of women with recurrent MDD receiving venlafaxine, and tendencies toward lower cardiovagal tone and cardiorespiratory coupling in women with recurrent MDD receiving escitalopram were observed when compared with healthy controls. Effect sizes for these differences were large between women receiving venlafaxine and healthy controls. We found a positive association between cardiorespiratory decoupling and venlafaxine dose. Norepinephrine-enhancement, within a therapeutic dose range, seems to be closely associated with decreased vagal tone and reduced nonlinear coupling between heart rate and respiration in euthymic women with recurrent MDD. However, the effects of serotonin enhancement on cardiovagal tone should be considered. Our results suggest that the pharmacodynamic properties of antidepressants may affect autonomic regulation of women with recurrent MDD even in euthymic state.

To live alone and to be depressed, an alarming combination for the renin-angiotensin-aldosterone-system (RAAS)

INTRODUCTION

The renin-angiotensin-aldosterone-system (RAAS) is one of the most important systems involved in the pathogenesis of cardiovascular diseases. Its role in stress response has been generally neglected, although the progression of cardiovascular disease is considerably increased in the presence of stress and especially in the presence of depression risk. With the present analysis we aimed to evaluate whether the activity of the RAAS correlates with depressive symptomatology and with chronic stress. Moreover, we aimed to analyse whether stress response is altered in the presence of depressed symptomatology. We chose "living alone" to be our paradigm of chronic stress.

METHODS AND RESULTS

Aldosterone and renin levels were assessed in 1743 (829 men, 914 women) from the population-based KORA study (Cooperative Health Research in the Region of Augsburg). The relationship between aldosterone, renin levels and the different combinations of living alone and depressive symptomatology was examined in three different multiple linear regression models adjusted for age, sex, creatinine levels, potassium levels, body mass index (BMI) and bio-behavioural factors. Neither "living alone" nor depressive symptomatology alone were associated with an activation of the RAAS, but the combination of living alone and depressive symptomatology yielded a highly significant increase in the aldosterone (p<0.01) and renin level (p=0.03).

CONCLUSION

Our findings show that depressive symptomatology is associated with a hyper-responsiveness to chronic stress. Under the condition of chronic stress depressed individuals have an activated RAAS. Activation of the RAAS might explain the known increased risk of negative cardiovascular disease outcomes in this group.

Effects of stress, depression, and their interaction on heart rate, skin conductance, finger temperature, and respiratory rate: sympathetic-parasympathetic hypothesis of stress and depression

We examined effects of stress, depression, and their interaction on sympathetic-parasympathetic responses, including percentage heart rate (PHR), percentage skin conductance (PSC), percentage finger temperature (PTEMP), and percentage respiratory rate (PRESPR). Participants were categorized into normal, low-risk, and high-risk depression groups under stress or no-stress by measuring psychophysiological responses. Stress increased PHR and PSC and decreased PTEMP. Depression negatively correlated with PHR and PTEMP. PSC and PTEMP were significantly dependent on and positively correlated with depression. PTEMP was significantly affected by the stress and depression interaction. Stress affects sympathetic, rather than parasympathetic, activity. Depression and the interaction between stress and depression initially associated with the sympathetic division and are then correlated with parasympathetic activity. A sympathetic-parasympathetic hypothesis and its clinical implications are discussed.

Autonomic modulation in healthy first-degree relatives of patients with major depressive disorder

BACKGROUND

Cardiac mortality is known to be increased in patients with major depression. Several studies have reported an imbalance within the autonomic nervous system (ANS) of patients with major depressive disorder (MDD) as one putative cause. Since a heritability of autonomic modulation was demonstrated in healthy subjects, we aimed to investigate autonomic modulation in first-degree relatives of patients with MDD to find potential autonomic imbalances.

METHODS

We included 30 patients with MDD, 30 of their first-degree relatives (siblings or offspring) and 30 matched healthy controls in our study. We obtained a high resolution electrocardiogram and beat to beat blood pressure measurements for 30 min at rest. Linear and nonlinear parameters of heart rate variability (HRV) and baroreflex sensitivity (BRS) were calculated.

RESULTS

Parameters of HRV and BRS did not differ significantly between relatives and controls. We found significant differences between patients and controls for some HRV and BRS parameters confirming results of previous studies.

DISCUSSION

Findings of our study suggest that an imbalance of autonomic function is related to patients with depression and not to first-degree relatives. Thus, a genetic background for autonomic dysfunction is rather unlikely.