Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease.

Depression is a risk factor for cardiovascular disease (CVD) perhaps mediated by hypothalamic-pituitary-adrenal (HPA) axis or vagal dysregulation. We investigated circadian mood variation and HPA-axis and autonomic function in older (55 years) depressed and nondepressed volunteers at risk for CVD by assessing diurnal positive and negative affect (PA, NA), cortisol, and cardiopulmonary variables in 46 moderately depressed and 19 nondepressed volunteers with elevated CVD risk. Participants sat quietly for 5-min periods (10:00, 12:00, 14:00, 17:00, 19:00, and 21:00), and then completed an electronic diary assessing PA and NA. Traditional and respiration-controlled heart rate variability (HRV) variables were computed for these periods as an index of vagal activity. Salivary cortisols were collected at waking, waking+30min, 12:00, 17:00, and 21:00h. Cortisol peaked in the early morning after waking, and gradually declined over the day, but did not differ between groups. PA was lower and NA was higher in the depressed group throughout the day. HRV did not differ between groups. Negative emotions were inversely related to respiratory sinus arrhythmia in nondepressed participants. We conclude that moderately depressed patients do not show abnormal HPA-axis function. Diurnal PA and NA distinguish depressed from nondepressed individuals at risk for CVD, while measures of vagal regulation, even when controlled for physical activity and respiratory confounds, do not. Diurnal mood variations of older individuals at risk for CVD differ from those reported for other groups and daily fluctuations in NA are not related to cardiac autonomic control in depressed individuals.

[1]  Dirk H. Hellhammer,et al.  The cortisol awakening response - normal values and confounds. , 2000, Noise & health.

[2]  P M Gustafsson,et al.  Evaluation of various models for respiratory inductance plethysmography calibration. , 1993, Journal of applied physiology.

[3]  C. Nemeroff,et al.  The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. , 1998, Archives of general psychiatry.

[4]  F. Wilhelm,et al.  Respiratory sinus arrhythmia, cardiac vagal control, and daily activity. , 2004, American journal of physiology. Heart and circulatory physiology.

[5]  Phyllis K. Stein,et al.  Association of depression witk reduced heart rate variability in coronary artery disease , 1995 .

[6]  F. Quitkin,et al.  Defining the boundaries of atypical depression: evidence from the HPA axis supports course of illness distinctions. , 2005, Journal of affective disorders.

[7]  D. Mohr,et al.  Depression and cortisol responses to psychological stress: A meta-analysis , 2005, Psychoneuroendocrinology.

[8]  P. Cowen,et al.  Increased salivary cortisol after waking in depression , 2005, Psychopharmacology.

[9]  Junichiro Hayano,et al.  Low heart rate variability and the effect of depression on post-myocardial infarction mortality. , 2005, Archives of internal medicine.

[10]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[11]  J. Saul,et al.  Transfer function analysis of the circulation: unique insights into cardiovascular regulation. , 1991, The American journal of physiology.

[12]  Yoshio Nakamura,et al.  Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. , 2000, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[13]  H. Schächinger,et al.  Hopelessness Is Associated With Decreased Heart Rate Variability During Championship Chess Games , 2003, Psychosomatic medicine.

[14]  H. Kraemer,et al.  Psychophysiological and Cortisol Responses to Psychological Stress in Depressed and Nondepressed Older Men and Women With Elevated Cardiovascular Disease Risk , 2006, Psychosomatic medicine.

[15]  J. Wardle,et al.  Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[16]  P Evans,et al.  The Awakening Cortisol Response: Methodological Issues and Significance , 2004, Stress.

[17]  G. Chrousos,et al.  Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states , 2002, Molecular Psychiatry.

[18]  Steven M. Pincus,et al.  A regularity statistic for medical data analysis , 1991, Journal of Clinical Monitoring.

[19]  H. Kraemer,et al.  Caution regarding the use of pilot studies to guide power calculations for study proposals. , 2006, Archives of general psychiatry.

[20]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[21]  A. Schatzberg,et al.  Cortisol Circadian Rhythm Alterations in Psychotic Major Depression , 2006, Biological Psychiatry.

[22]  James A. Blumenthal,et al.  Depression, Heart Rate Variability, and Acute Myocardial Infarction , 2001, Circulation.

[23]  C. Nemeroff,et al.  Psychoneuroendocrinology of depression. Hypothalamic-pituitary-adrenal axis. , 1998, The Psychiatric clinics of North America.

[24]  D. Heitjan,et al.  Mixed-effects models in psychophysiology. , 2000, Psychophysiology.

[25]  W. Browner,et al.  Depression and heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. , 2005, Archives of general psychiatry.

[26]  J. Wardle,et al.  Mild acute inflammatory stimulation induces transient negative mood , 2004, Journal of Psychosomatic Research.

[27]  J. Fahrenberg,et al.  Cortisol, ACTH, and cardiovascular response to a cognitive challenge paradigm in aging and depression. , 1995, The American journal of physiology.

[28]  A. Sherwood,et al.  Effects of daily stress on autonomic cardiac control in patients with coronary artery disease. , 2004, The American journal of cardiology.

[29]  R. Carney,et al.  Depression is a risk factor for mortality in coronary heart disease. , 2004, Psychosomatic medicine.

[30]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[31]  B. McEwen,et al.  Association of depression with medical illness: does cortisol play a role? , 2004, Biological Psychiatry.

[32]  Cavit Boz,et al.  Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment , 2002, Psychiatry Research.

[33]  C. Taylor,et al.  The effects of cognitive behavior therapy on depression in older patients with cardiovascular risk , 2008, Depression and anxiety.

[34]  H. Kraemer,et al.  Depression and Stress Reactivity in Metastatic Breast Cancer , 2006, Psychosomatic medicine.

[35]  P. Grossman,et al.  Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions , 2007, Biological Psychology.

[36]  R. Larsen,et al.  Diurnal patterns of unpleasant mood: associations with neuroticism, depression, and anxiety. , 1998, Journal of personality.

[37]  J. Vaidya,et al.  The two general activation systems of affect: Structural findings, evolutionary considerations, and psychobiological evidence , 1999 .

[38]  D. Watson,et al.  Development and validation of brief measures of positive and negative affect: the PANAS scales. , 1988, Journal of personality and social psychology.

[39]  J. Calabrese,et al.  The relevance of the in- versus outpatient status for studies on HPA-axis in depression: Spontaneous hypercortisolism is a feature of major depressed inpatients and not of major depression per se , 1994, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[40]  David Watson,et al.  Diurnal variation in the Positive Affects , 1989 .

[41]  John Trinder,et al.  MOOD AND THE CIRCADIAN SYSTEM: INVESTIGATION OF A CIRCADIAN COMPONENT IN POSITIVE AFFECT , 2002, Chronobiology international.

[42]  Helena C Kraemer,et al.  Centring in regression analyses: a strategy to prevent errors in statistical inference , 2004, International journal of methods in psychiatric research.

[43]  Frank H Wilhelm,et al.  Respiratory sinus arrhythmia as a predictor of outcome in major depressive disorder. , 2002, Journal of affective disorders.

[44]  R. Carney,et al.  The Depression Interview and Structured Hamilton (DISH): Rationale, Development, Characteristics, and Clinical Validity , 2002, Psychosomatic medicine.

[45]  J. Gorman,et al.  Effect of mental stress throughout the day on cardiac autonomic control , 1994, Biological Psychology.

[46]  Frank H Wilhelm,et al.  The LifeShirt , 2003, Behavior modification.