Selective Unilateral Autonomic Activation: Implications for Psychiatry

ABSTRACT Research advances have led to three methods for selectively activating one half of the autonomic nervous system in humans.The first method is an ancient yogic technique called unilateral forced nostril breathing (UFNB) that employs forced breathing through only one nostril while closing off the other. The second method works by stimulation of an autonomic reflex point on the fifth intercostal space near the axilla. The most recent method employs unilateral vagus nerve stimulation (VNS) via the mid-inferior cervical branch and requires surgical implantation of a wire and pacemaker. UFNB is non-invasive and seems to selectively activate the ipsilateral branch of the sympathetic nervous system with a possible compensation effect leading to contralateral VNS. UFNB and VNS have been employed to treat psychiatric disorders. While UFNB has been studied for its potential effects on the endogenous ultradian rhythms of the autonomic and central nervous system, and their tightly coupled correlates, VNS has yet to be studied in this regard. This article reviews these three methods and discusses their similarities, putative mechanisms, their studied effects on the endogenous autonomic nervous system and central nervous system rhythms, and their implications for the treatment of psychiatric disorders.

[1]  D. Heetderks.  OBSERVATIONS ON THE REACTION OF NORMAL NASAL MUCOUS MEMBKANE , 1927 .

[2]  A. Šercer.  Investigations sur l'influence réflectoire de la cavité nasale sur le poumon du měme côté , 1930 .

[3]  J. Beattie,et al.  The effects of hypothalamic stimulation on gastric motility , 1934, The Journal of physiology.

[4]  J. Beattie,et al.  THE EFFECTS OF DIENCEPHALIC STIMULATION ON URINARY BLADDER TONUS , 1936 .

[5]  J. O. Foley,et al.  Quantitative studies of the vagus nerve in the cat. I. The ratio of sensory to motor fibers , 1937 .

[6]  A. Friedell.  Automatic attentive breathing in angina pectoris. , 1948, Minnesota medicine.

[7]  K. Takagi,et al.  A SWEAT REFLEX DUE TO PRESSURE ON THE BODY SURFACE , 1950 .

[8]  P. Stoksted.  Rhinometric measurements for determination of the nasal cycle. , 1953, Acta oto-laryngologica. Supplementum.

[9]  W. R. Hess.  Diencephalon : autonomic and extrapyramidal functions , 1955 .

[10]  W. R. Ingram.  THE HYPOTHALAMUS , 1938, Ciba clinical symposia.

[11]  P. Stoksted.  Obstructions in the Nose and Their Influence on the Pulmonary Functions , 1960 .

[12]  M. N. Levy,et al.  Functional Distribution of the Peripheral Cardiac Sympathetic Pathways , 1966, Circulation research.

[13]  N. Kleitman.  Phylogenetic, ontogenetic and environmental determinants in the evolution of sleep-wakefulness cycles. , 1967, Research publications - Association for Research in Nervous and Mental Disease.

[14]  C. R. Smith,et al.  Effects of vagal stimulation on S-A and A-V nodes. , 1968, The American journal of physiology.

[15]  A. Konno.  [Air flow and resistance in the nasal cavity. 2. Bilateral rhinometry using a pneumotachometer. Its principles and clinical application]. , 1969, Nihon Jibiinkoka Gakkai kaiho.

[16]  A. Konno.  [Air flow and resistance in the nasal cavity. 1. Observation on nasal airflow, using the model made from nasal and nasopharyngeal casts of the human body]. , 1969, Nihon Jibiinkoka Gakkai kaiho.

[17]  B. Drettner.  Pathophysiological Relationship between the Upper and Lower Airways , 1970, The Annals of otology, rhinology, and laryngology.

[18]  S. Rao,et al.  Nasal airflow with body in various positions. , 1970, Journal of applied physiology.

[19]  R. Linden,et al.  Chronotropic and inotropic effects on the dog heart of stimulating the efferent cardiac sympathetic nerves , 1973, The Journal of physiology.

[20]  Furnival Cm,et al.  Chronotropic and inotropic effects on the dog heart of stimulating the efferent cardiac sympathetic nerves. , 1973 .

[21]  H. J. Hoffman,et al.  A 90-min cardiac biorhythm: methodology and data analysis using modified periodograms and complex demodulation. , 1974, IEEE transactions on bio-medical engineering.

[22]  H De Geest,et al.  Additive effects of acetylcholine released by vagal nerve stimulation on atrial rate. , 1975, Journal of applied physiology.

[23]  W. Cowan,et al.  Direct hypothalamo-autonomic connections , 1976, Brain Research.

[24]  Z. Servít,et al.  Activating Effect of Nasal and Oral Hyperventilation on Epileptic Electrographic Phenomena: Reflex Mechanisms of Nasal Origin , 1981, Epilepsia.

[25]  D. Kripke,et al.  Ultradian circa 11/2 hour rhythms: a multioscillatory system. , 1981, Life sciences.

[26]  N. Kleitman,et al.  Basic rest-activity cycle--22 years later. , 1982, Sleep.

[27]  F. Bloom,et al.  Alternating cerebral hemispheric activity and the lateralization of autonomic nervous function. , 1983, Human neurobiology.

[28]  Bickford Rg,et al.  Alternating cerebral hemispheric activity and the lateralization of autonomic nervous function. , 1983 .

[29]  J. Haight,et al.  Posture and nasal patency. , 1984, The American review of respiratory disease.

[30]  P. Cole,et al.  Reciprocating nasal airflow resistances. , 1984, Acta oto-laryngologica.

[31]  C. Saper,et al.  Organization of cerebral cortical afferent systems in the rat. II. Hypothalamocortical projections , 1985, The Journal of comparative neurology.

[32]  D. Shannahoff-Khalsa,et al.  Nasal airflow asymmetries and human performance , 1986, Biological Psychology.

[33]  J. Haight,et al.  Unilateral nasal resistance and asymmetrical body pressure. , 1986, The Journal of otolaryngology. Supplement.

[34]  D. Shannahoff-Khalsa,et al.  Alternating lateralization of plasma catecholamines and nasal patency in humans. , 1986, Life sciences.

[35]  J. Haight,et al.  Posture and the Nasal Cycle , 1986, The Annals of otology, rhinology, and laryngology.

[36]  R. Bickford,et al.  Selective hemispheric stimulation by unilateral forced nostril breathing. , 1987, Human neurobiology.

[37]  I Ninomiya,et al.  [Neural control of the heart]. , 1987, Kokyu to junkan. Respiration & circulation.

[38]  J. Backon,et al.  Effect of forced unilateral nostril breathing on blink rates: relevance to hemispheric lateralization of dopamine. , 1989, The International journal of neuroscience.

[39]  W. C. Lynch,et al.  Unilateral nostril breathing influences lateralized cognitive performance , 1989, Brain and Cognition.

[40]  F. Yates,et al.  Ultradian adrenocortical and circulatory oscillations in conscious dogs. , 1990, The American journal of physiology.

[41]  D. Shannahoff-Khalsa,et al.  The effects of unilateral forced nostril breathing on cognition. , 1991, The International journal of neuroscience.

[42]  D. Shannahoff-Khalsa.  Lateralized rhythms of the central and autonomic nervous systems. , 1991, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[43]  D. Shannahoff-Khalsa,et al.  The effects of unilateral forced nostril breathing on cognitive performance. , 1993, The International journal of neuroscience.

[44]  D. Shannahoff-Khalsa,et al.  The ultradian rhythm of alternating cerebral hemispheric activity. , 1993, The International journal of neuroscience.

[45]  D. Shannahoff-Khalsa,et al.  The effects of unilateral forced nostril breathing on the heart. , 1993, The International journal of neuroscience.

[46]  H. Nagendra,et al.  Breathing through a particular nostril can alter metabolism and autonomic activities. , 1994, Indian journal of physiology and pharmacology.

[47]  Forced Single-Nostril Breathing and Cognition , 1994, Perceptual and motor skills.

[48]  Lippincott Williams Wilkins,et al.  A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures , 1995, Neurology.

[49]  B. Schiff,et al.  Asymmetrical Hemispheric Activation and Emotion - The Effects of Unilateral Forced Nostril Breathing , 1995, Brain and Cognition.

[50]  A. Hamberger,et al.  Effects of vagus nerve stimulation on amino acids and other metabolites in the CSF of patients with partial seizures , 1995, Epilepsy Research.

[51]  B. Uthman,et al.  Vagus nerve stimulation for the treatment of medically intractable seizures. Results of a 1-year open-extension trial. Vagus Nerve Stimulation Study Group. , 1996, Archives of neurology.

[52]  H. Nagendra,et al.  Physiological measures of right nostril breathing. , 1996, Journal of alternative and complementary medicine.

[53]  Basim M. Uthman,et al.  Vagus Nerve Stimulation for the Treatment of Medically Intractable Seizures: Results of a 1-Year Open-Extension Trial , 1996 .

[54]  D. Shannahoff-Khalsa,et al.  Ultradian rhythms of autonomic, cardiovascular, and neuroendocrine systems are related in humans. , 1996, The American journal of physiology.

[55]  D. Shannahoff-Khalsa,et al.  Clinical case report: efficacy of yogic techniques in the treatment of obsessive compulsive disorders. , 1996, The International journal of neuroscience.

[56]  D. Shannahoff-Khalsa,et al.  Low-frequency ultradian insulin rhythms are coupled to cardiovascular, autonomic, and neuroendocrine rhythms. , 1997, The American journal of physiology.

[57]  G. Morris,et al.  Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01-E05. , 1999, Neurology.

[58]  D. Shannahoff-Khalsa,et al.  Randomized Controlled Trial of Yogic Meditation Techniques for Patients With Obsessive-Compulsive Disorder , 1999, CNS Spectrums.

[59]  Wade M. Mueller,et al.  Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy , 1999, Neurology.

[60]  A. Rush,et al.  VAGUS NERVE STIMULATION , 2000 .

[61]  F E Yates,et al.  Ultradian Sleep Rhythms of Lateral Eeg, Autonomic, and Cardiovascular Activity Are Coupled in Humans , 2000, The International journal of neuroscience.

[62]  Robert Goodman,et al.  Vagus nerve stimulation (VNS) for treatment-resistant depressions: a multicenter study∗ ∗ See accompanying Editorial, in this issue. , 2000, Biological Psychiatry.

[63]  J. Rosenbaum,et al.  Vagus nerve stimulation for treatment-resistant depression , 2000, Biological Psychiatry.

[64]  C. Saper.  Hypothalamic connections with the cerebral cortex. , 2000, Progress in brain research.

[65]  R. Eccles,et al.  Nasal Airflow in Health and Disease , 2000, Acta oto-laryngologica.

[66]  R. Gilmartin,et al.  Prospective Long‐Term Study of Vagus Nerve Stimulation for the Treatment of Refractory Seizures , 2000, Epilepsia.

[67]  D. Shannahoff-Khalsa.  UNIIATERAL FORCED NOSTRIL BREATHING: Basic Science, Clinical Trials, and Selected Advanced Techniques , 2001 .

[68]  D. Shannahoff-Khalsa,et al.  Ultradian rhythms of alternating cerebral hemispheric EEG dominance are coupled to rapid eye movement and non-rapid eye movement stage 4 sleep in humans. , 2001, Sleep medicine.

[69]  Cole A. Giller,et al.  Vagus Nerve Stimulation (VNS™) for Treatment-Resistant Depression: Efficacy, Side Effects, and Predictors of Outcome , 2001, Neuropsychopharmacology.

[70]  S. Baglio,et al.  MEG signals spatial power distribution and gamma band activity in yoga breathing exercises , 2002, Proceedings of the Second Joint 24th Annual Conference and the Annual Fall Meeting of the Biomedical Engineering Society] [Engineering in Medicine and Biology.

[71]  H. Sackeim,et al.  Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes , 2002, Biological Psychiatry.

[72]  Thomas R. Henry,et al.  Therapeutic mechanisms of vagus nerve stimulation , 2002, Neurology.

[73]  S. Dane,et al.  Brief Communication EFFECTS OF UNILATERAL NOSTRIL BREATHING ON BLOOD PRESSURE AND HEART RATE IN RIGHT-HANDED HEALTHY SUBJECTS , 2002, The International journal of neuroscience.

[74]  H. Sackeim,et al.  Vagus nerve stimulation (VNS): utility in neuropsychiatric disorders. , 2003, The international journal of neuropsychopharmacology.

[75]  E. Hollander,et al.  A qualitative analysis of nonresponse: management of treatment-refractory obsessive-compulsive disorder. , 2004, The Journal of clinical psychiatry.

[76]  S. C. Reddy,et al.  Modulation of Intraocular Pressure by Unilateral and Forced Unilateral Nostril Breathing in Young Healthy Human Subjects , 2004, International Ophthalmology.

[77]  N. Shapira,et al.  A Review of the Treatment for Refractory Obsessive-Compulsive Disorder: From Medicine to Deep Brain Stimulation , 2004, CNS Spectrums.

[78]  K. Schmid,et al.  Effect of unilateral forced nostril breathing on tonic accommodation and intraocular pressure , 2004, Clinical Autonomic Research.

[79]  J. P. Karplus,et al.  Gehirn und Sympathicus , 1909, Archiv für die gesamte Physiologie des Menschen und der Tiere.

[80]  Barry R. Rittberg,et al.  Effects of 12 Months of Vagus Nerve Stimulation in Treatment-Resistant Depression: A Naturalistic Study , 2005, Biological Psychiatry.

[81]  Mustafa M. Husain,et al.  Vagus Nerve Stimulation for Treatment-Resistant Depression: A Randomized, Controlled Acute Phase Trial , 2005, Biological Psychiatry.

[82]  V. Brown,et al.  Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects , 2005, Neuroscience & Biobehavioral Reviews.

[83]  P. Beickert.  Halbseitenrhythmus der vegetativen Innervation , 1951, Archiv für Ohren-, Nasen- und Kehlkopfheilkunde.

[84]  A. Rush,et al.  Two-year outcome of vagus nerve stimulation (VNS) for treatment of major depressive episodes. , 2005, The Journal of clinical psychiatry.

[85]  J. P. Karplus,et al.  Gehirn und Sympathicus , 1910, Pflüger's Archiv für die gesamte Physiologie des Menschen und der Tiere.

[86]  Alan Frazer,et al.  VNS Therapy in Treatment-Resistant Depression: Clinical Evidence and Putative Neurobiological Mechanisms , 2006, Neuropsychopharmacology.

[87]  K. Hatton,et al.  Vagal Nerve Stimulation: Overview and Implications for Anesthesiologists , 2006, Anesthesia and analgesia.

[88]  David Shannahoff-Khalsa,et al.  Kundalini Yoga Meditation: Techniques Specific for Psychiatric Disorders, Couples Therapy, and Personal Growth , 2006 .

[89]  S. Telles,et al.  Immediate Effect of Three Yoga Breathing Techniques on Performance on a Letter-Cancellation Task , 2007, Perceptual and motor skills.

[90]  S. Dane,et al.  Handedness, eyedness and nasal cycle in children with autism , 2007, International Journal of Developmental Neuroscience.

[91]  N. Kleitman.  The Nature of Dreaming , 2008 .

[92]  D. Shannahoff-Khalsa.  Psychophysiological states: the ultradian dynamics of mind-body interactions. , 2007, International review of neurobiology.

[93]  J. Beattie.  HYPOTHALAMIC MECHANISMS. , 2022, Canadian Medical Association journal.