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Heart rate and high frequency heart rate variability during stress as biomarker for clinical depression. A systematic review

Published online by Cambridge University Press:  23 August 2018

Carmen Schiweck Open the ORCID record for Carmen Schiweck [Opens in a new window] ,
Deborah Piette Open the ORCID record for Deborah Piette [Opens in a new window] ,
Daniel Berckmans ,
Stephan Claes  and
Elske Vrieze
Carmen Schiweck*
Affiliation:
Department of Neurosciences, Psychiatry Research Group, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
Deborah Piette
Affiliation:
M3-BIORES, Division Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Kasteelpark Arenberg 30, 3001 Heverlee, Belgium
Daniel Berckmans
Affiliation:
M3-BIORES, Division Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Kasteelpark Arenberg 30, 3001 Heverlee, Belgium
Stephan Claes
Affiliation:
Department of Neurosciences, Psychiatry Research Group, University of Leuven, Herestraat 49, 3000 Leuven, Belgium University Psychiatric Center, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
Elske Vrieze
Affiliation:
Department of Neurosciences, Psychiatry Research Group, University of Leuven, Herestraat 49, 3000 Leuven, Belgium University Psychiatric Center, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
*
Author for correspondence: Carmen Schiweck, E-mail: carmen.schiweck@kuleuven.be
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Abstract

The interaction of physical and mental vulnerability and environmental constraints is thought to foster the development of psychiatric disorders such as major depressive disorder (MDD). A central factor in the development of psychopathology is mental stress. Despite some evidence for parasympathetic withdrawal and sympathetic overactivity in MDD, the psychophysiological response to stress in depression is not clear-cut. Given the growing interest in heart rate and heart rate variability as indicators for remote monitoring of patients, it is important to understand how patients with MDD react to stress in a laboratory-controlled environment. We conducted a systematic review of studies using electrocardiography to derive heart rate and heart rate variability during stress in patients with clinical depression. We focused on well-validated stress tasks- the mental arithmetic stress task, the Trier social stress task and public speaking task- to minimize confounding effects due to the nature of the stressor. The majority of studies found hypo-reactivity during stress as a hallmark of depression as evidenced by lower fluctuation in heart rate and heart rate variability in the high-frequency band. We address the potential underlying biological mechanisms, the influence of covariates on these measures and briefly discuss the specificity and potential for remote monitoring by using these variables.

Keywords

Anxiety disorderdepressionheart rate variabilitypsychophysiologyrespiratory sinus arrhythmiastress reactivity

Information

Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 2 , January 2019 , pp. 200 - 211
Copyright
Copyright © Cambridge University Press 2018 

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References

Akil, H (2005) Stressed and depressed. Nature Medicine 11, 116–118.Google Scholar
Atchley, R, Ellingson, R, Klee, D, Memmott, T and Oken, B (2017) A cognitive stressor for event-related potential studies: the portland arithmetic stress task. Stress-the International Journal on the Biology of Stress 20, 277–284.Google Scholar
Barton, DA, Dawood, T, Lambert, EA, Esler, MD, Haikerwal, D, Brenchley, C, Socratous, F, Kaye, DM, Schlaich, MP and Hickie, I (2007) Sympathetic activity in major depressive disorder: identifying those at increased cardiac risk? Journal of Hypertension 25, 2117–2124.Google Scholar
Beauchaine, TP and Thayer, JF (2015) Heart rate variability as a transdiagnostic biomarker of psychopathology. International Journal of Psychophysiology 98, 338–350.Google Scholar
Billman, GE (2013) The lf/hf ratio does not accurately measure cardiac sympatho-vagal balance. Frontiers in Physiology 4, 26.Google Scholar
Brindle, RC, Ginty, AT and Conklin, SM (2013) Is the association between depression and blunted cardiovascular stress reactions mediated by perceptions of stress? International Journal of Psychophysiology 90, 66–72.Google Scholar
Bylsma, LM, Salomon, K, Taylor-Clift, A, Morris, BH and Rottenberg, J (2014) Respiratory sinus arrhythmia reactivity in current and remitted major depressive disorder. Psychosomatic Medicine 76, 66–73.Google Scholar
Camm, AJ, Malik, M, Bigger, JT, Breithardt, G, Cerutti, S, Cohen, RJ, Coumel, P, Fallen, EL, Kennedy, HL and Kleiger, R (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. European Heart Journal 17, 354–381.Google Scholar
Carney, RM and Freedland, KE (2009) Depression and heart rate variability in patients with coronary heart disease. Cleveland Clinic Journal of Medicine 76, S13.Google Scholar
Caviola, S, Carey, E, Mammarella, IC and Szucs, D (2017) Stress, time pressure, strategy selection and math anxiety in mathematics: a review of the literature. Frontiers in Psychology 8, 13.Google Scholar
Chalmers, JA, Quintana, DS, Maree, J, Abbott, A and Kemp, AH (2014) Anxiety disorders are associated with reduced heart rate variability: A meta-analysis. Frontiers in Psychiatry 5, 80.Google Scholar
Chida, Y and Hamer, M (2008) Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: A quantitative review of 30 years of investigations. American Psychological Association. Psychological Bulletin, 134, 829–885.Google Scholar
Clancy, JA, Mary, DA, Witte, KK, Greenwood, JP, Deuchars, SA and Deuchars, J (2014) Non-invasive vagus nerve stimulation in healthy humans reduces sympathetic nerve activity. Brain Stimulation 7, 871–877.Google Scholar
Cohen, S, Janicki-Deverts, D and Miller, GE (2007) Psychological stress and disease. Jama 298, 1685–1687.Google Scholar
Cohen, BE, Edmondson, D and Kronish, IM (2015) State of the art review: depression, stress, anxiety, and cardiovascular disease. American Journal of Hypertension 28, 1295–1302.Google Scholar
Cyranowski, JM, Hofkens, TL, Swartz, HA, Salomon, K and Gianaros, PJ (2011) Cardiac vagal control in nonmedicated depressed women and nondepressed controls: impact of depression status, lifetime trauma history, and respiratory factors. Psychosomatic Medicine 73, 336–343.Google Scholar
Dekker, JM, Crow, RS, Folsom, AR, Hannan, PJ, Liao, D, Swenne, CA and Schouten, EG (2000) Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes. Circulation 102, 1239.Google Scholar
Dickerson, SS and Kemeny, ME (2004). Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bulletin 130, 355–391.Google Scholar
Ernst, G (2014) Heart rate variability. E-book library [online]. Available at: https://link.springer.com/content/pdf/10.1007/978-1-4471-4309-3.pdf (Accessed: 20 July 2018)Google Scholar
Ehrenthal, JC, Herrmann-Lingen, C, Fey, M and Schauenburg, H (2010) Altered cardiovascular adaptability in depressed patients without heart disease. The World Journal of Biological Psychiatry 11, 586–593.Google Scholar
Gordon, JL, Ditto, B and D'Antono, B (2012) Cognitive depressive symptoms associated with delayed heart rate recovery following interpersonal stress in healthy men and women. Psychophysiology 49, 1082–1089.Google Scholar
Grippo, AJ, Moffitt, JA and Johnson, AK (2002) Cardiovascular alterations and autonomic imbalance in an experimental model of depression. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 282, R1333–R1341.Google Scholar
Guinjoan, SM, Bernabo, JL and Cardinali, DP (1995) Cardiovascular tests of autonomic function and sympathetic skin responses in patients with major depression. Journal of Neurology Neurosurgery and Psychiatry 59, 299–302.Google Scholar
Hamilton, JL and Alloy, LB (2016) Atypical reactivity of heart rate variability to stress and depression across development: systematic review of the literature and directions for future research. Clinical Psychology Reviews 50, 67–79.Google Scholar
Hammen, C (2005) Stress and depression. Annual Review of Clinical Psychology 1, 293–319.Google Scholar
Hankin, BL and Abramson, LY (2001) Development of gender differences in depression: an elaborated cognitive vulnerability–transactional stress theory. Psychological Bulletin 127, 773.Google Scholar
Hausberg, M, Hillebrand, U and Kisters, K (2007) Addressing sympathetic overactivity in major depressive disorder. Journal of Hypertension 25, 2004–2005.Google Scholar
Hu, MX, Lamers, F, de Geus, EJ and Penninx, BW (2016) Differential autonomic nervous system reactivity in depression and anxiety during stress depending on type of stressor. Psychosomatic Medicine 78, 562–572.Google Scholar
Hughes, JW and Stoney, CM (2000) Depressed mood is related to high-frequency heart rate variability during stressors. Psychosomatic Medicine 62, 796–803.Google Scholar
Kemp, AH, Quintana, DS, Gray, MA, Felmingham, KL, Brown, K and Gatt, JM (2010) Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biological Psychiatry 67, 1067–1074.Google Scholar
Kessler, RC (1997) The effects of stressful life events on depression. Annual Review of Psychology 48, 191–214.Google Scholar
Kircanski, K, Waugh, CE, Camacho, MC and Gotlib, IH (2016) Aberrant parasympathetic stress responsivity in pure and co-occurring major depressive disorder and generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment 38, 5–19.Google Scholar
Kirschbaum, C, Pirke, KM and Hellhammer, DH (1993) The ‘trier social stress test’ – a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 28, 76–81.Google Scholar
Koenig, J and Thayer, JF (2016) Sex differences in healthy human heart rate variability: a meta-analysis. Neuroscience & Biobehavioral Reviews 64, 288–310.Google Scholar
Krishnan, V and Nestler, EJ (2008) The molecular neurobiology of depression. Nature 455, 894–902.Google Scholar
Kudielka, BM, Buske-Kirschbaum, A, Hellhammer, DH and Kirschbaum, C (2004) Differential heart rate reactivity and recovery after psychosocial stress (TSST) in healthy children, younger adults, and elderly adults: the impact of age and gender. International Journal of Behavioral Medicine 11, 116–121.Google Scholar
Laborde, S, Mosley, E and Thayer, JF (2017) Heart rate variability and cardiac vagal tone in psychophysiological research – recommendations for experiment planning, data analysis, and data reporting. Frontiers in Psychology 8, 213.Google Scholar
Lang, PJ and McTeague, LM (2009) The anxiety disorder spectrum: fear imagery, physiological reactivity, and differential diagnosis. Anxiety, Stress, and Coping 22, 5–25.Google Scholar
Liang, CS, Lee, JF, Chen, CC and Chang, YC (2015) Reactive heart rate variability in male patients with first-episode major depressive disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry 56, 52–57.Google Scholar
Licht, CM, de Geus, EJ, Zitman, FG, Hoogendijk, WJ, van Dyck, R and Penninx, BW (2008) Association between major depressive disorder and heart rate variability in the netherlands study of depression and anxiety (nesda). Archives of General Psychiatry 65, 1358–1367.Google Scholar
Licht, CM, de Geus, EJ, van Dyck, R and Penninx, BW (2010 a) Longitudinal evidence for unfavorable effects of antidepressants on heart rate variability. Biological Psychiatry 68, 861–868.Google Scholar
Licht, CM, Vreeburg, SA, van Reedt Dortland, AK, Giltay, EJ, Hoogendijk, WJ, DeRijk, RH, Vogelzangs, N, Zitman, FG, de Geus, EJ and Penninx, BW (2010 b) Increased sympathetic and decreased parasympathetic activity rather than changes in hypothalamic-pituitary-adrenal axis activity is associated with metabolic abnormalities. The Journal of Clinical Endocrinology & Metabolism 95, 2458–2466.Google Scholar
Licht, CM, Penninx, BW and de Geus, EJ (2011) To include or not to include? A response to the meta-analysis of heart rate variability and depression. Biological Psychiatry 69, e1.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG and The, PG (2009) Preferred reporting items for systematic reviews and meta-analyses: the prisma statement. PLOS Medicine 6, e1000097.Google Scholar
Musselman, DL, Evans, DL and Nemeroff, CB (1998) The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Archives of General Psychiatry 55, 580–592.Google Scholar
Ordaz, S and Luna, B (2012) Sex differences in physiological reactivity to acute psychosocial stress in adolescence. Psychoneuroendocrinology 37, 1135–1157.Google Scholar
Ottaviani, C, Shapiro, D, Davydov, DM, Goldstein, IB and Mills, PJ (2009) The autonomic phenotype of rumination. International Journal of Psychophysiolgy 72, 267–275.Google Scholar
Park, SE, Park, D, Song, K-I, Seong, J-K, Chung, S and Youn, I (2017) Differential heart rate variability and physiological responses associated with accumulated short-and long-term stress in rodents. Physiology & Behavior 171, 21–31.Google Scholar
Porges, SW (2007) The polyvagal perspective. Biological Psychology 74, 116–143.Google Scholar
Quintana, DS, Elstad, M, Kaufmann, T, Brandt, CL, Haatveit, B, Haram, M, Nerhus, M, Westlye, LT and Andreassen, OA (2016) Resting-state high-frequency heart rate variability is related to respiratory frequency in individuals with severe mental illness but not healthy controls. Scientific Reports 6, 37212.Google Scholar
Reyes del Paso, GA, Langewitz, W, Mulder, LJ, Roon, A and Duschek, S (2013) The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology 50, 477–487.Google Scholar
Rottenberg, J, Clift, A, Bolden, S and Salomon, K (2007) Rsa fluctuation in major depressive disorder. Psychophysiology 44, 450–458.Google Scholar
Salomon, K, Bylsma, LM, White, KE, Panaite, V and Rottenberg, J (2013) Is blunted cardiovascular reactivity in depression mood-state dependent? A comparison of major depressive disorder remitted depression and healthy controls. International Journal of Psychophysiology 90, 50–57.Google Scholar
Salomon, K, Clift, A, Karlsdottir, M and Rottenberg, J (2009) Major depressive disorder is associated with attenuated cardiovascular reactivity and impaired recovery among those free of cardiovascular disease. Health Psychology 28, 157–165.Google Scholar
Salomon, K and Jin, A (2013). Diathesis-stress model. In Gellman, MD and Turner, JR (eds), Encyclopedia of Behavioral Medicine. New York, NY: Springer New York. 591–592.Google Scholar
Scalco, AZ, Rondon, MU, Trombetta, IC, Laterza, MC, Azul, JB, Pullenayegum, EM, Scalco, MZ, Kuniyoshi, FH, Wajngarten, M and Negrão, CE (2009) Muscle sympathetic nervous activity in depressed patients before and after treatment with sertraline. Journal of Hypertension 27, 2429–2436.Google Scholar
Schwerdtfeger, A and Friedrich-Mai, P (2009) Social interaction moderates the relationship between depressive mood and heart rate variability: evidence from an ambulatory monitoring study. Health Psychology 28, 501–509.Google Scholar
Schwerdtfeger, A and Rosenkaimer, A-K (2011) Depressive symptoms and attenuated physiological reactivity to laboratory stressors. Biological Psychology 87, 430–438.Google Scholar
Shaffer, JA, Whang, W, Shimbo, D, Burg, M, Schwartz, JE and Davidson, KW (2012) Do different depression phenotypes have different risks for recurrent coronary heart disease? Health Psychology Review 6, 165–179.Google Scholar
Shaffer, F, McCraty, R and Zerr, CL (2014) A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Frontiers in Psychology 5, 1040.Google Scholar
Shinba, T, Kariya, N, Matsui, Y, Ozawa, N, Matsuda, Y and Yamamoto, KI (2008) Decrease in heart rate variability response to task is related to anxiety and depressiveness in normal subjects. Psychiatry and Clinical Neurosciences 62, 603–609.Google Scholar
Sparrenberger, F, Cichelero, F, Ascoli, A, Fonseca, F, Weiss, G, Berwanger, O, Fuchs, S, Moreira, L and Fuchs, F (2009) Does psychosocial stress cause hypertension? A systematic review of observational studies. Journal of Human Hypertension 23, 12–19.Google Scholar
Stange, JP, Alloy, LB and Fresco, DM (2017) Inflexibility as a vulnerability to depression: a systematic qualitative review. Clinical Psychology: Science and Practice 24, 245–276.Google Scholar
Taylor, CB, Conrad, A, Wilhelm, FH, Neri, E, DeLorenzo, A, Kramer, MA, Giese-Davis, J, Roth, WT, Oka, R, Cooke, JP, Kraemer, H and Spiegel, D (2006) Psychophysiological and cortisol responses to psychological stress in depressed and nondepressed older men and women with elevated cardiovascular disease risk. Psychosomatic Medicine 68, 538–546.Google Scholar
Thayer, JF, Yamamoto, SS and Brosschot, JF (2010) The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International Journal of Cardiology 141, 122–131.Google Scholar
Tell, D, Mathews, HL, Burr, RL and Witek Janusek, L (2018) During stress, heart rate variability moderates the impact of childhood adversity in women with breast cancer. Stress 21, 179–187.Google Scholar
Van der Kooy, K, van Hout, H, Marwijk, H, Marten, H, Stehouwer, C and Beekman, A (2007) Depression and the risk for cardiovascular diseases: systematic review and meta analysis. International Journal of Geriatric Psychiatry 22, 613–626.Google Scholar
Van Ockenburg, SL, Tak, LM, Bakker, SJ, Gans, RO, de Jonge, P and Rosmalen, JG (2015) Effects of adverse life events on heart rate variability, cortisol, and c-reactive protein. Acta Psychiatrica Scandinavia 131, 40–50.Google Scholar
Voellmin, A, Winzeler, K, Hug, E, Wilhelm, FH, Schaefer, V, Gaab, J, La Marca, R, Pruessner, JC and Bader, K (2015) Blunted endocrine and cardiovascular reactivity in young healthy women reporting a history of childhood adversity. Psychoneuroendocrinology 51, 58–67.Google Scholar
Westenberg, PM, Bokhorst, CL, Miers, AC, Sumter, SR, Kallen, VL, van Pelt, J and Blöte, AW (2009) A prepared speech in front of a pre-recorded audience: subjective, physiological, and neuroendocrine responses to the Leiden public speaking task. Biological Psychology 82, 116–124.Google Scholar
Wilhelm, FH and Grossman, P (2010) Emotions beyond the laboratory: theoretical fundaments, study design, and analytic strategies for advanced ambulatory assessment. Biological Psychology 84, 552–569.Google Scholar
Winzeler, K, Voellmin, A, Hug, E, Kirmse, U, Helmig, S, Princip, M, Cajochen, C, Bader, K and Wilhelm, FH (2017) Adverse childhood experiences and autonomic regulation in response to acute stress: the role of the sympathetic and parasympathetic nervous systems. Anxiety, Stress, & Coping 30, 145–154.Google Scholar
Wulsin, LR and Singal, BM (2003) Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine 65, 201–210.Google Scholar
Zbozinek, TD, Rose, RD, Wolitzky-Taylor, KB, Sherbourne, C, Sullivan, G, Stein, MB, Roy-Byrne, PP and Craske, MG (2012) Diagnostic overlap of generalized anxiety disorder and major depressive disorder in a primary care sample. Depression and Anxiety 29, 1065–1071.Google Scholar
Zorn, JV, Schur, RR, Boks, MP, Kahn, RS, Joels, M and Vinkers, CH (2017) Cortisol stress reactivity across psychiatric disorders: a systematic review and meta-analysis. Psychoneuroendocrinology 77, 25–36.Google Scholar
Zuckerman, M (1999) Diathesis-stress models. In Zuckerman, M., Vulnerability to psychopathology: A biosocial model. Washington, DC, US: American Psychological Association, pp. 3–23. doi: http://dx.doi.org/10.1037/10316-001Google Scholar
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