Related Experiment Videos
Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart
P K Stein1, R M Carney, K E Freedland
1Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. steinph@medicine.wustl.edu
Insights
Moderate to severe depression significantly reduces heart rate variability in cardiac patients. This finding in coronary heart disease patients suggests altered autonomic function and increased mortality risk.
Area of Science:
- Cardiology
- Psychiatry
- Autonomic Nervous System Research
Background:
- Depression is a common comorbidity in patients with coronary heart disease (CHD).
- Altered autonomic nervous system (ANS) function, indicated by reduced heart rate variability (HRV), is associated with adverse cardiovascular outcomes.
Purpose of the Study:
- To investigate the relationship between depression severity and HRV in patients with stable CHD.
- To determine if depression impacts cardiac autonomic modulation in this patient population.
Main Methods:
- 40 depressed and 32 non-depressed CHD outpatients underwent 24-hour ambulatory electrocardiographic (ECG) monitoring.
- Beta-blockers and antidepressant medications were discontinued prior to HRV assessment.
- Depression severity was classified using Beck Depression Inventory scores (mild vs. moderate-to-severe).
Main Results:
- No significant demographic or clinical differences between groups, except for depression status.
- Moderately-to-severely depressed patients exhibited significantly higher heart rates and reduced HRV indices compared to non-depressed patients.
- Mildly depressed patients showed trends towards higher heart rates and lower HRV, but these did not reach statistical significance.
Conclusions:
- Moderate to severe depression is associated with significantly reduced heart rate variability in stable CHD patients.
- This reduction in HRV may indicate impaired cardiac autonomic modulation.
- The findings suggest a potential mechanism linking depression to increased mortality risk in cardiac patients.
Objective:
The purpose of this study was to investigate the relationship between depression and heart rate variability in cardiac patients.
Methods:
Heart rate variability was measured during 24-hour ambulatory electrocardiographic (ECG) monitoring in 40 medically stable out-patients with documented coronary heart disease meeting current diagnostic criteria for major depression, and 32 nondepressed, but otherwise comparable, patients. Patients discontinued beta-blockers and antidepressant medications at the time of study. Depressed patients were classified as mildly (n = 21) or moderately-to-severely depressed (n = 19) on the basis of Beck Depression Inventory scores.
Results:
There were no significant differences among the groups in age, gender, blood pressure, history of myocardial infarction, diabetes, or smoking. Heart rates were higher and nearly all indices of heart rate variability were significantly reduced in the moderately-to-severely versus the nondepressed group. Heart rates were also higher and mean values for heart rate variability lower in the mildly depressed group compared with the nondepressed group, but these differences did not attain statistical significance.
Conclusion:
The association of moderate to severe depression with reduced heart rate variability in patients with stable coronary heart disease may reflect altered cardiac autonomic modulation and may explain their increased risk for mortality.