Background
Depression is associated with an increase in the likelihood of cardiac events; however,
studies investigating the relationship between depression and heart rate variability
(HRV) have generally focused on patients with cardiovascular disease (CVD). The objective
of the current report is to examine with meta-analysis the impact of depression and
antidepressant treatment on HRV in depressed patients without CVD.
Methods
Studies comparing 1) HRV in patients with major depressive disorder and healthy control
subjects and 2) the HRV of patients with major depressive disorder before and after
treatment were considered for meta-analysis.
Results
Meta-analyses were based on 18 articles that met inclusion criteria, comprising a
total of 673 depressed participants and 407 healthy comparison participants. Participants
with depression had lower HRV (time frequency: Hedges' g = −.301, p < .001; high frequency: Hedges' g = −.293, p < .001; nonlinear: Hedges' g = −1.955, p = .05; Valsalva ratio: Hedges' g = −.712, p < .001) than healthy control subjects, and depression severity was negatively correlated
with HRV (r = −.354, p < .001). Tricyclic medication decreased HRV, although serotonin reuptake inhibitors,
mirtazapine, and nefazodone had no significant impact on HRV despite patient response
to treatment.
Conclusions
Depression without CVD is associated with reduced HRV, which decreases with increasing
depression severity, most apparent with nonlinear measures of HRV. Critically, a variety
of antidepressant treatments do not resolve these decreases despite resolution of
symptoms, highlighting that antidepressant medications might not have HRV-mediated
cardioprotective effects and the need to identify individuals at risk among patients
in remission.
Key Words
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Article info
Publication history
Published online: February 08, 2010
Accepted:
December 6,
2009
Received:
November 4,
2009
Identification
Copyright
© 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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