Association Between Major Depressive Disorder and Heart Rate Variability in the Netherlands Study of Depression and Anxiety (NESDA)

被引:283
作者
Licht, Carmilla M. M. [1 ]
de Geus, Eco J. C. [2 ,3 ]
Zitman, Frans G. [4 ]
Hoogendijk, Witte J. G. [1 ,3 ]
van Dyck, Richard [1 ]
Penninx, Brenda W. J. H. [1 ,4 ,5 ]
机构
[1] Vrije Univ Amsterdam Med Ctr, Dept Psychiat, Inst Res Extramural Med, NL-1081 HL Amsterdam, Netherlands
[2] Vrije Univ Amsterdam, Dept Biol Psychol, Amsterdam, Netherlands
[3] Vrije Univ Amsterdam, Ctr Neurogenom & Cognit Res, Amsterdam, Netherlands
[4] Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands
[5] Univ Groningen, Univ Med Ctr Groningen, Dept Psychiat, NL-9713 AV Groningen, Netherlands
关键词
D O I
10.1001/archpsyc.65.12.1358
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Context: It has been hypothesized that depression is associated with lower heart rate variability and decreased cardiac vagal control. This may play an important role in the risk of cardiovascular disease among depressed individuals. Objective: To determine whether heart rate variability was lower in depressed individuals than in healthy controls in a large adult sample. Design: Cross-sectional analyses from a large depression cohort study. Setting: The Netherlands Study of Depression and Anxiety. Participants: Two thousand three hundred seventy-three individuals ( mean age, 41.8 years; 66.8% female) who participated in the Netherlands Study of Depression and Anxiety. Included were 524 controls, 774 individuals with a diagnosis of major depressive disorder ( MDD) earlier in life ( remitted MDD), and 1075 individuals with current MDD based on the Composite International Diagnostic Interview. This sample was sufficiently powered to examine the confounding effects of lifestyle, comorbid anxiety, and antidepressants. Main Outcome Measures: The standard deviation of normal-to-normal beats ( SDNN) and cardiac vagal control, as indexed by respiratory sinus arrhythmia ( RSA), were measured during 1 1/2 hours of ambulatory recording of electrocardiograms and thorax impedance. Multivariate analyses were conducted to compare SDNN and RSA across depression groups after adjustment for demographics, health, lifestyle, comorbid anxiety, and psychoactive medication. Results: Individuals with remitted and current MDD had a lower mean SDNN and RSA compared with controls ( SDNN, 3.1-5.7 milliseconds shorter, P <=.02; RSA, 5.1-7.1 milliseconds shorter, P <. 001; effect size, 0.125-0.269). Comorbid anxiety and lifestyle did not reduce these associations. However, accounting for psychoactive medication removed the association with SDNN and strongly attenuated the association with RSA. Depressed individuals who were using selective serotonin reuptake inhibitors, tricyclic antidepressants, or other antidepressants had significantly shorter SDNNs and RSAs ( effect size, 0.207-0.862) compared with controls and depressed individuals not taking medication. Conclusions: This study shows that depression is associated with significantly lowered heart rate variability. However, this association appears to be mainly driven by the effect of antidepressants.
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收藏
页码:1358 / 1367
页数:10
相关论文
共 56 条
[31]   The relationship of depression to cardiovascular disease -: Epidemiology, biology, and treatment [J].
Musselman, DL ;
Evans, DL ;
Nemeroff, CB .
ARCHIVES OF GENERAL PSYCHIATRY, 1998, 55 (07) :580-592
[32]   Elevated heart rate: A major risk factor for cardiovascular disease [J].
Palatini, P ;
Jullius, S .
CLINICAL AND EXPERIMENTAL HYPERTENSION, 2004, 26 (7-8) :637-644
[33]   The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods [J].
Penninx, Brenda W. J. H. ;
Beekman, Aartjan T. F. ;
Smit, Johannes H. ;
Zitman, Frans G. ;
Nolen, Willem A. ;
Spinhoven, Philip ;
Cuijpers, Pim ;
De Jong, Peter J. ;
Van Marwijk, Harm W. J. ;
Assendelft, Willem J. J. ;
Van Der Meer, Klaas ;
Verhaak, Peter ;
Wensing, Michel ;
De Graaf, Ron ;
Hoogendijk, Witte J. ;
Ormel, Johan ;
Van Dyck, Richard .
INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, 2008, 17 (03) :121-140
[34]   Depression and cardiac mortality -: Results from a community-based longitudinal study [J].
Penninx, BWJH ;
Beekman, ATF ;
Honig, A ;
Deeg, DJH ;
Schoevers, RA ;
van Eijk, JTM ;
van Tilburg, W .
ARCHIVES OF GENERAL PSYCHIATRY, 2001, 58 (03) :221-227
[35]   Emotion: An evolutionary by-product of the neural regulation of the autonomic nervous system [J].
Porges, SW .
INTEGRATIVE NEUROBIOLOGY OF AFFILIATION, 1997, 807 :62-77
[36]   CARDIAC VAGAL TONE - A PHYSIOLOGICAL INDEX OF STRESS [J].
PORGES, SW .
NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS, 1995, 19 (02) :225-233
[37]   The polyvagal theory: phylogenetic substrates of a social nervous system [J].
Porges, SW .
INTERNATIONAL JOURNAL OF PSYCHOPHYSIOLOGY, 2001, 42 (02) :123-146
[38]   HEART-RATE-VARIABILITY IN DEPRESSED-PATIENTS AND DIFFERENTIAL-EFFECTS OF PAROXETINE AND AMITRIPTYLINE ON CARDIOVASCULAR AUTONOMIC FUNCTIONS [J].
RECHLIN, T ;
WEIS, M ;
CLAUS, D .
PHARMACOPSYCHIATRY, 1994, 27 (03) :124-128
[39]   ARE AFFECTIVE-DISORDERS ASSOCIATED WITH ALTERATIONS OF HEART-RATE-VARIABILITY [J].
RECHLIN, T ;
WEIS, M ;
SPITZER, A ;
KASCHKA, WP .
JOURNAL OF AFFECTIVE DISORDERS, 1994, 32 (04) :271-275
[40]   HEART-RATE ANALYSIS IN 24 PATIENTS TREATED WITH 150 MG AMITRIPTYLINE PER DAY [J].
RECHLIN, T ;
CLAUS, D ;
WEIS, M .
PSYCHOPHARMACOLOGY, 1994, 116 (01) :110-114