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Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis

Andrew H Kemp1, Daniel S Quintana, Marcus A Gray

  • 1School of Psychology, University of Sydney, Sydney, Australia. andrew.kemp@sydney.edu.au

Biological Psychiatry
|February 9, 2010
PubMed

Insights

Depression in individuals without cardiovascular disease is linked to lower heart rate variability (HRV), which worsens with increased depression severity. Antidepressant treatments may not improve HRV, even when symptoms resolve.

Area of Science:

  • Cardiology
  • Psychiatry
  • Autonomic Nervous System Research

Background:

  • Depression is a known risk factor for cardiac events.
  • Previous research on depression and heart rate variability (HRV) primarily focused on patients with existing cardiovascular disease (CVD).
  • The impact of depression and its treatment on HRV in individuals without CVD remains less understood.

Purpose of the Study:

  • To meta-analyze the relationship between depression and HRV in patients without CVD.
  • To investigate the effect of antidepressant treatment on HRV in this population.

Main Methods:

  • Meta-analysis of 18 studies including 673 depressed patients and 407 healthy controls.
  • Comparison of HRV between depressed individuals and healthy controls.
  • Assessment of HRV changes in depressed patients before and after antidepressant treatment.

Main Results:

  • Depressed individuals exhibited significantly lower HRV across time-frequency, high-frequency, nonlinear, and Valsalva ratio measures compared to healthy controls.
  • A negative correlation was found between depression severity and HRV.
  • Tricyclic antidepressants reduced HRV, while selective serotonin reuptake inhibitors, mirtazapine, and nefazodone did not significantly impact HRV despite symptom improvement.

Conclusions:

  • Depression in the absence of CVD is associated with reduced HRV, particularly evident in nonlinear measures, and this reduction correlates with depression severity.
  • Antidepressant therapies may not restore HRV to normal levels, even with symptom remission.
  • This suggests that current antidepressant medications may lack HRV-mediated cardioprotective effects, necessitating identification of at-risk individuals among those in remission.
Abstract

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