The association between depressive disorder and cardiac autonomic control in adults 60 years and older
Carmilla M M Licht1, Paul Naarding, Brenda W J H Penninx
1From the GGZinGeest/Department of Psychiatry (Licht, Penninx, Comijs) and EMGO+ Institute (Licht, Penninx, de Geus, Comijs), VU University Medical Center, Amsterdam, the Netherlands; Department of Old-Age Psychiatry (Naarding), GGNet, Apeldoorn/Zutphen, the Netherlands; Department of Psychiatry (van der Mast), Leiden University Medical Center, Leiden, the Netherlands; and Department of Biological Psychology (de Geus), VU University, Amsterdam, the Netherlands.
Insights
Depression did not significantly alter cardiac autonomic control in older adults. However, antidepressant use was linked to reduced parasympathetic control, with tricyclic antidepressants also associated with increased sympathetic control.
Area of Science:
- Cardiology
- Psychiatry
- Gerontology
Background:
- Altered cardiac autonomic control is linked to depression and increased cardiovascular disease (CVD) risk.
- This association is particularly relevant in older adults (60+ years) due to age-related CVD risk.
- Understanding this link is crucial for managing cardiovascular health in aging populations with depression.
Purpose of the Study:
- To investigate the association between depressive disorders and cardiac autonomic control in older adults.
- To examine the influence of antidepressant use on cardiac autonomic function in this population.
- To explore the impact of specific antidepressant classes on cardiac autonomic parameters.
Main Methods:
- The study included 321 individuals with depressive disorders and 115 controls from the Netherlands Study of Depression in Older Persons.
- Key cardiac autonomic measures, including respiratory sinus arrhythmia (RSA), heart rate (HR), and preejection period (PEP), were assessed.
- Statistical analyses compared these measures between depressed individuals and controls, considering antidepressant use and clinical characteristics.
Main Results:
- Depressed individuals showed significantly lower RSA and marginally higher HR compared to controls, with no significant difference in PEP.
- Antidepressant use markedly attenuated the observed associations between depression and HR/RSA.
- Antidepressant-naïve depressed individuals had similar cardiac autonomic function to controls; antidepressant users exhibited lower RSA, and tricyclic antidepressant users showed higher HR and shorter PEP.
Conclusions:
- Depression itself was not significantly associated with altered cardiac autonomic control in this cohort of older adults.
- Antidepressant use, however, was strongly associated with impaired cardiac autonomic control, specifically reduced parasympathetic activity.
- Tricyclic antidepressants were further linked to heightened sympathetic activity, underscoring their distinct impact on autonomic function.
Background:
Altered cardiac autonomic control has often been reported in depressed persons and might play an important role in the increased risk for cardiovascular disease (CVD). A negative association between cardiac autonomic control and depression might become specifically clinically relevant in persons 60 years or older as CVD risk increases with age.
Methods:
This study included data of 321 persons with a depressive disorder and 115 controls participating in the Netherlands Study of Depression in Older Persons (mean age = 70.3 years, 65.7% female). Respiratory sinus arrhythmia (RSA), heart rate (HR), and preejection period (PEP) were measured and compared between depressed persons and controls. In addition, the role of antidepressants and clinical characteristics (e.g., age of depression onset and comorbid anxiety) was examined.
Results:
Compared with controls, depressed persons had lower RSA (mean [standard error of the mean] = 23.5 [1.2] milliseconds versus 18.6 [0.7] milliseconds, p = .001, d = 0.373) and marginally higher HR (73.1 [1.1] beats/min versus 75.6 [0.6] beats/min, p = .065, d = 0.212), but comparable PEP (113.9 [2.1] milliseconds versus 112.0 [1.2] milliseconds, p = .45, d = 0.087), fully adjusted. Antidepressants strongly attenuated the associations between depression and HR and RSA. Antidepressant-naïve depressed persons had similar HR and RSA to controls, whereas users of antidepressants showed significantly lower RSA. In addition, tricyclic antidepressant users had higher HR (p < .001, d = 0.768) and shorter PEP (p = .014, d = 0.395) than did controls.
Conclusions:
Depression was not associated with cardiac autonomic control, but antidepressants were in this sample. All antidepressants were associated with low cardiac parasympathetic control and specifically tricyclic antidepressants with high cardiac sympathetic control.
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