Is cardiac autonomic control affected in major depressive disorder? A systematic review of heart rate variability
Federica Goffi1, Eleonora Maggioni1,2, Anna Maria Bianchi1,3
1Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy.
Insights
Major depressive disorder (MDD) is linked to autonomic dysregulation, specifically reduced vagal activity. This suggests impaired emotion regulation in MDD patients, impacting their ability to adjust flexibly.
Area of Science:
- Psychiatry and Neuroscience
- Cardiology
- Autonomic Nervous System Research
Background:
- Major Depressive Disorder (MDD) is a complex psychiatric condition associated with increased cardiovascular disease risk.
- Autonomic dysregulation is a key pathophysiological factor in MDD, often assessed via Heart Rate Variability (HRV).
Purpose of the Study:
- To systematically review and interpret HRV studies to understand autonomic regulation in MDD.
- To identify reproducible insights into the autonomic characteristics of individuals with MDD.
Main Methods:
- A systematic literature search identified 30 eligible articles.
- Studies compared short-term resting-state HRV measures between drug-free MDD patients and healthy controls without cardiovascular disease.
Main Results:
- Significant differences in HRV measures were observed between MDD patients and controls, particularly in markers of vagal activity.
- Nonlinear HRV measures, though used less frequently, showed higher sensitivity in detecting autonomic changes in MDD.
Conclusions:
- MDD is characterized by a reduced parasympathetic tone.
- This autonomic imbalance, within the polyvagal theory framework, may correlate with difficulties in emotion regulation and adaptive flexibility in MDD.
Introduction:
Major depressive disorder (MDD) is a heterogeneous psychiatric disorder that is a risk factor for cardiovascular diseases. Autonomic dysregulation, estimated as an important correlated pathophysiological cause, was investigated in many studies mainly through a quantitative evaluation of the heart rate variability (HRV).
Aim:
The objective of this review was to provide any reproducible insights on autonomic regulation characteristics of MDD through the selection, revision, and joint interpretation of a restricted sample of studies based on systematic criteria.
Methods:
The literature research resulted in thirty eligible articles that reported the comparison of short-term resting-state HRV measures between drug-free MDD patients and healthy controls, excluding subjects affected by cardiovascular diseases.
Results:
Most of the reviewed studies reported significant differences between MDD patients and controls in the investigated HRV measures, especially for those that mainly reflect vagal activity. Nonlinear measures, although computed by fewer studies, seem to be more sensitive in detecting autonomic changes in MDD.
Conclusions:
Our findings can be considered as evidence that the intrinsic autonomic state of MDD is characterized by decreased parasympathetic tone, which, interpreted in the context of the polyvagal theory, might be associated with impaired emotion regulation and flexible adjustment in MDD.
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