A literature review of heart rate variability in depressive and bipolar disorders

Objective: Autonomic nervous system dysfunction has the potential to adversely impact general medical health and is known to exist in a number of psychiatric disorders. It reflects alterations in the function of several regions of the central nervous system. Measurement of heart rate variability provides a non-invasive tool for studying autonomic function. While the literature relating to the technical process of heart rate variability and aspects of depressive disorders has been reviewed in the past, research relating to both depressive and bipolar disorders has not been comprehensively reviewed. This paper critically considers the published research in heart rate variability in both depressive and bipolar affective disorders. Method: A literature search using Medline, EMBASE, PsycINFO, ProQuest Psychology and references included in published literature was conducted using the following keywords: ‘heart rate variability and autonomic, combined with depression, depressive disorder, bipolar, mania and sleep’. Results: The evidence demonstrates that, using heart rate variability measures, significant distortions of autonomic function are evident in both depressive and bipolar disorders and from most of their pharmacological treatments. Conclusion: The autonomic dysfunction evident in both unipolar and bipolar affective disorders, and many psychotropic medications, has significant implications for our understanding of the neurophysiology of these disorders, their treatment and associated general health.

[1]  D. T. Kaplan,et al.  Aging and the complexity of cardiovascular dynamics. , 1991, Biophysical journal.

[2]  D. Mozaffarian,et al.  Physical Activity and Heart Rate Variability in Older Adults: The Cardiovascular Health Study , 2014, Circulation.

[3]  Hagit Cohen,et al.  Impaired heart rate variability in euthymic bipolar patients. , 2003, Bipolar disorders.

[4]  K. Felmingham,et al.  Depression, Comorbid Anxiety Disorders, and Heart Rate Variability in Physically Healthy, Unmedicated Patients: Implications for Cardiovascular Risk , 2012, PloS one.

[5]  Seung-Hwan Lee,et al.  Comparative Study of Heart Rate Variability in Patients with Schizophrenia, Bipolar Disorder, Post-traumatic Stress Disorder, or Major Depressive Disorder , 2013, Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology.

[6]  A. Steiger,et al.  Wake and sleep EEG provide biomarkers in depression. , 2010, Journal of psychiatric research.

[7]  Jeffrey J Borckardt,et al.  Brain stimulation for the treatment of psychiatric disorders , 2007, Current opinion in psychiatry.

[8]  Jonathan Rottenberg,et al.  Cardiac vagal control in depression: A critical analysis , 2007, Biological Psychology.

[9]  San-Yuan Huang,et al.  Distinguishing bipolar II depression from unipolar major depressive disorder: Differences in heart rate variability , 2015, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[10]  E. Ernst,et al.  Yoga for Heart Rate Variability: A Systematic Review and Meta-analysis of Randomized Clinical Trials , 2015, Applied psychophysiology and biofeedback.

[11]  J. Vagedes,et al.  How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram. , 2013, International journal of cardiology.

[12]  J. Davidson,et al.  Effects of Paroxetine and Venlafaxine XR on Heart Rate Variability in Depression , 2005, Journal of clinical psychopharmacology.

[13]  S. Nevsimalova,et al.  Spectral analysis of heart rate variability in sleep. , 2005, Physiological Research.

[14]  Cheryl C. H. Yang,et al.  Impact of Antipsychotics and Anticholinergics on Autonomic Modulation in Patients With Schizophrenia , 2013, Journal of clinical psychopharmacology.

[15]  R. Lane,et al.  A model of neurovisceral integration in emotion regulation and dysregulation. , 2000, Journal of affective disorders.

[16]  Ronald D Berger,et al.  Heart Rate Variability , 2006, Journal of cardiovascular electrophysiology.

[17]  J. Pearl.  Causality: Models, Reasoning and Inference , 2000 .

[18]  J. Thayer,et al.  Heart period variability and depressive symptoms: gender differences , 1998, Biological Psychiatry.

[19]  Angelo Gemignani,et al.  REM sleep dysregulation in depression: state of the art. , 2013, Sleep medicine reviews.

[20]  Garry Egger,et al.  Castaways , 2009 .

[21]  Magdalena Romanowicz,et al.  Changes in heart rate variability associated with acute alcohol consumption: current knowledge and implications for practice and research. , 2011, Alcoholism, clinical and experimental research.

[22]  A. Guastella,et al.  Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis. , 2016, Journal of psychiatry & neuroscience : JPN.

[23]  Marcus W. Agelink,et al.  Effects of Newer Atypical Antipsychotics on Autonomic Neurocardiac Function: A Comparison Between Amisulpride, Olanzapine, Sertindole, and Clozapine , 2001, Journal of clinical psychopharmacology.

[24]  Martin P Paulus,et al.  Heart rate variability in bipolar mania and schizophrenia. , 2010, Journal of psychiatric research.

[25]  R. Mccraty,et al.  Coherence: bridging personal, social, and global health. , 2010, Alternative therapies in health and medicine.

[26]  Anna M. Bianchi,et al.  Modulation of the Sympatho-Vagal Balance during Sleep: Frequency Domain Study of Heart Rate Variability and Respiration , 2012, Front. Physio..

[27]  Jung‐Sun Lee,et al.  Heart rate variability in the subsyndromal depressive phase of bipolar disorder , 2012, Psychiatry and clinical neurosciences.

[28]  Anna M. Bianchi,et al.  Study of Heart Rate Variability in Bipolar Disorder: Linear and Non-Linear Parameters during Sleep , 2012, Front. Neuroeng..

[29]  Daehyun Yoon,et al.  Short-term heart rate variability in older patients with newly diagnosed depression , 2015, Psychiatry Research.

[30]  Arsenio Veicsteinas,et al.  Heart rate variability and autonomic activity at rest and during exercise in various physiological conditions , 2003, European Journal of Applied Physiology.

[31]  Daniel S Quintana,et al.  The relationship between mental and physical health: insights from the study of heart rate variability. , 2013, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[32]  Andrew H. Kemp,et al.  Major depressive disorder with melancholia displays robust alterations in resting state heart rate and its variability: implications for future morbidity and mortality , 2014, Front. Psychol..

[33]  Andreas Voss,et al.  Influence of age and gender on complexity measures for short term heart rate variability analysis in healthy subjects , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[34]  S. Porges.  The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system , 2009, Cleveland Clinic Journal of Medicine.

[35]  Y. Hirayasu,et al.  Dose-dependent effect of antipsychotic drugs on autonomic nervous system activity in schizophrenia , 2012, BMC Psychiatry.

[36]  Effects of Serotonin Reuptake Inhibitors on Heart Rate Variability: Methodological Issues, Medical Comorbidity, and Clinical Relevance , 2011, Biological Psychiatry.

[37]  A. Wierzbicka,et al.  Effects of Antidepressants on Sleep , 2017, Current Psychiatry Reports.

[38]  R. Malhotra,et al.  Sleep and Mental Illness , 2011 .

[39]  J. Kingsley,et al.  Acute and training effects of resistance exercise on heart rate variability , 2016, Clinical physiology and functional imaging.

[40]  Julian F Thayer,et al.  Effects of depression, anxiety, comorbidity, and antidepressants on resting-state heart rate and its variability: an ELSA-Brasil cohort baseline study. , 2014, The American journal of psychiatry.

[41]  M. Obermeier,et al.  Heart Rate Variability and Omega-3 Index in Euthymic Patients with Bipolar Disorders , 2015, European Psychiatry.

[42]  F. Shaffer,et al.  A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability , 2014, Front. Psychol..

[43]  M. Detke,et al.  Evaluation of the Effects of Duloxetine and Escitalopram on 24-Hour Heart Rate Variability: A Mechanistic Study Using Heart Rate Variability as a Pharmacodynamic Measure , 2013, Journal of clinical psychopharmacology.

[44]  J. Chung,et al.  Effect of Acupuncture on Heart Rate Variability: A Systematic Review , 2014, Evidence-based complementary and alternative medicine : eCAM.

[45]  D. Todder,et al.  Nonlinear analysis of RR interval in euthymic bipolar disorder , 2005, Autonomic Neuroscience.

[46]  Claudio Gentili,et al.  Clinical state assessment in bipolar patients by means of HRV features obtained with a sensorized T-shirt , 2012, 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[47]  G. Billman.  The effect of heart rate on the heart rate variability response to autonomic interventions , 2013, Front. Physiol..

[48]  A. Kemp,et al.  Physiological Correlates of Bipolar Spectrum Disorders and their Treatment. , 2014, Current topics in behavioral neurosciences.

[49]  T. Lancaster,et al.  Instrumental variables and inverse probability weighting for causal inference from longitudinal observational studies , 2004, Statistical methods in medical research.

[50]  Andre R Brunoni,et al.  A systematic review and meta-analysis of heart rate variability in epilepsy and antiepileptic drugs. , 2012, Epilepsia.

[51]  A. Kemp,et al.  The impact of escitalopram on vagally mediated cardiovascular function to stress and the moderating effects of vigorous physical activity: a randomized controlled treatment study in healthy participants , 2013, Front. Physiol..

[52]  M. Siepmann,et al.  The effects of moclobemide on autonomic and cognitive functions in healthy volunteers. , 2004, Pharmacopsychiatry.

[53]  C. Morin,et al.  Sleep disturbances in bipolar disorder during remission. , 2013, Journal of affective disorders.

[54]  C. Finucane,et al.  Antidepressants strongly influence the relationship between depression and heart rate variability: findings from The Irish Longitudinal Study on Ageing (TILDA) , 2014, Psychological Medicine.

[55]  P. Stein,et al.  Heart Rate Variability: Measurement and Clinical Utility , 2005, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[56]  A Voss,et al.  Linear and nonlinear methods for analyses of cardiovascular variability in bipolar disorders. , 2006, Bipolar disorders.

[57]  S. Bacon,et al.  Improvements in heart rate variability with exercise therapy. , 2010, The Canadian journal of cardiology.

[58]  K. Felmingham,et al.  Impact of Depression and Antidepressant Treatment on Heart Rate Variability: A Review and Meta-Analysis , 2010, Biological Psychiatry.

[59]  J. Thayer,et al.  Heart Rate Variability, Prefrontal Neural Function, and Cognitive Performance: The Neurovisceral Integration Perspective on Self-regulation, Adaptation, and Health , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[60]  Yiming Wang,et al.  Altered cardiac autonomic nervous function in depression , 2013, BMC Psychiatry.

[61]  James A. J. Heathers,et al.  Everything Hertz: methodological issues in short-term frequency-domain HRV , 2014, Front. Physiol..

[62]  M. Desseilles,et al.  Heart rate variability: a tool to explore the sleeping brain? , 2014, Front. Neurosci..

[63]  J. Prasko,et al.  Comorbidity bipolar disorder and personality disorders. , 2013, Neuro endocrinology letters.

[64]  Eduard Vieta,et al.  Safety and efficacy of Vagus Nerve Stimulation in treatment-resistant depression. A systematic review. , 2008, Journal of affective disorders.

[65]  James A. J. Heathers,et al.  Considerations in the assessment of heart rate variability in biobehavioral research , 2014, Front. Psychol..

[66]  L. Mulder,et al.  The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. , 2013, Psychophysiology.

[67]  J. Gorman,et al.  Heart rate variability in depressive and anxiety disorders. , 2000, American heart journal.

[68]  A. Kemp,et al.  Impact of escitalopram on vagally mediated cardiovascular function in healthy participants: implications for understanding differential age-related, treatment emergent effects , 2013, Psychopharmacology.

[69]  S. Kennedy,et al.  Neurostimulation therapies for treatment resistant depression: A focus on vagus nerve stimulation and deep brain stimulation , 2011, International review of psychiatry.

[70]  R. Carney,et al.  Change in Heart Rate and Heart Rate Variability During Treatment for Depression in Patients With Coronary Heart Disease , 2000, Psychosomatic medicine.

[71]  San-Yuan Huang,et al.  Heart rate variability in unmedicated patients with bipolar disorder in the manic phase , 2014, Psychiatry and clinical neurosciences.

[72]  N. Stapelberg,et al.  Mind and heart: Heart rate variability in major depressive disorder and coronary heart disease - a review and recommendations , 2012, The Australian and New Zealand journal of psychiatry.

[73]  M. Tohen,et al.  Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort , 2013, International journal of methods in psychiatric research.

[74]  Paul McCrone,et al.  Bipolar Disorder: Clinical and Neurobiological Foundations , 2010 .

[75]  J. Sacha,et al.  Alterations of an average heart rate change heart rate variability due to mathematical reasons. , 2008, International journal of cardiology.

[76]  Anthony S. Leicht,et al.  The role of physical activity and heart rate variability for the control of work related stress , 2014, Front. Physiol..

[77]  J. Thayer,et al.  eview meta-analysis of heart rate variability and neuroimaging studies : Implications or heart rate variability as a marker of stress and health , 2012 .

[78]  Toshikazu Shinba,et al.  Altered autonomic activity and reactivity in depression revealed by heart‐rate variability measurement during rest and task conditions , 2014, Psychiatry and clinical neurosciences.

[79]  Anna M. Bianchi,et al.  Methods for heart rate variability analysis during sleep , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[80]  Luca Carnevali,et al.  Autonomic dysfunction and heart rate variability in depression , 2015, Stress.

[81]  Lino Nobili,et al.  Heart rate variability in normal and pathological sleep , 2013, Front. Physiol..

[82]  A. Mohamed,et al.  Withdrawal of anti-epileptic medications during video EEG monitoring does not alter ECG parameters or HRV , 2013, Epilepsy Research.

[83]  D. Palomba,et al.  Somatic, but not cognitive–affective, symptoms are associated with reduced heart rate variability in individuals with dysphoria , 2015, Front. Psychol..

[84]  Thomas Kubiak,et al.  Cardiac vagal tone is associated with social engagement and self-regulation , 2013, Biological Psychology.

[85]  R Ramana,et al.  Residual symptoms after partial remission: an important outcome in depression , 1995, Psychological Medicine.

[86]  Marcus W. Agelink,et al.  Effects of reboxetine, a selective norepinephrine reuptake inhibitor, on sympathetic and parasympathetic outflow to the heart: preliminary data , 2002, Psychopharmacology.

[87]  Shih-Jen Tsai,et al.  Reduced physiologic complexity is associated with poor sleep in patients with major depression and primary insomnia. , 2011, Journal of affective disorders.

[88]  E. Williamson,et al.  Introduction to propensity scores , 2014, Respirology.

[89]  C. Pizzi,et al.  Heart rate variability today. , 2012, Progress in cardiovascular diseases.

[90]  U. Rajendra Acharya,et al.  Heart rate variability: a review , 2006, Medical and Biological Engineering and Computing.

[91]  T. Kaufmann,et al.  Reduced heart rate variability in schizophrenia and bipolar disorder compared to healthy controls , 2016, Acta psychiatrica Scandinavica.

[92]  T. Raju,et al.  Differential actions of antidepressant treatments on cardiac autonomic alterations in depression: A prospective comparison. , 2011, Asian journal of psychiatry.

[93]  Y. Hishikawa,et al.  Alcohol has a dose-related effect on parasympathetic nerve activity during sleep. , 2011, Alcoholism, clinical and experimental research.

[94]  Louis T van Zyl,et al.  Effects of antidepressant treatment on heart rate variability in major depression: A quantitative review , 2008, BioPsychoSocial medicine.

[95]  W. Zareba,et al.  Heart rate variability. , 2013, Handbook of clinical neurology.

[96]  P. Stein,et al.  Insights from the study of heart rate variability. , 1999, Annual review of medicine.

[97]  B. Penninx,et al.  Reply to: Effects of Serotonin Reuptake Inhibitors on Heart Rate Variability: Methodological Issues, Medical Comorbidity, and Clinical Relevance , 2011, Biological Psychiatry.

[98]  S. Duval,et al.  Modulation of the autonomic nervous system assessed through heart rate variability by a mindfulness based stress reduction program. , 2014, International journal of cardiology.

[99]  Sheri L. Johnson,et al.  Emotional and physiological responses to normative and idiographic positive stimuli in bipolar disorder. , 2011, Journal of affective disorders.

[100]  J. D. den Boer,et al.  Pituitary-Adrenal and Sympathetic Nervous System Responses to Stress in Women Remitted From Recurrent Major Depression , 2008, Psychosomatic medicine.

[101]  Stefan Leucht,et al.  Clinical implications of Brief Psychiatric Rating Scale scores. , 2005, The British journal of psychiatry : the journal of mental science.

[102]  Michael Taylor,et al.  Breathing frequency bias in fractal analysis of heart rate variability , 2009, Biological Psychology.

[103]  M. Deuschle,et al.  Heart Rate Variability During Antidepressant Treatment With Venlafaxine and Mirtazapine , 2013, Clinical neuropharmacology.

[104]  Guy A Dumont,et al.  Circadian variation of heart rate variability across sleep stages. , 2013, Sleep.

[105]  F. Fregni,et al.  Heart rate variability is a trait marker of major depressive disorder: evidence from the sertraline vs. electric current therapy to treat depression clinical study. , 2013, The international journal of neuropsychopharmacology.

[106]  Enzo Pasquale Scilingo,et al.  Maximal-radius multiscale entropy of cardiovascular variability: A promising biomarker of pathological mood states in bipolar disorders , 2014, 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[107]  D H Singer,et al.  Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. , 1998, Journal of the American College of Cardiology.

[108]  S. Munjal,et al.  Heart Rate Variability Increases With Reductions in Cigarette Smoke Exposure After 3 Days , 2009, Journal of cardiovascular pharmacology and therapeutics.

[109]  T. Komatsu,et al.  Differential effects of ketamine and midazolam on heart rate variability , 1995, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[110]  Michele A. Parker,et al.  Relationship of Heart Rate Variability to Parasympathetic Effect , 2001, Circulation.

[111]  J. Fiedorowicz,et al.  Effects of antipsychotic drugs on cardiovascular variability in participants with bipolar disorder , 2014, Human psychopharmacology.