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Association between Anxiety Disorders and Heart Rate Variability in The Netherlands Study of Depression and Anxiety (NESDA)
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Objective: To determine whether patients with different types of anxiety disorder (panic disorder, social phobia, generalized anxiety disorder) have higher heart rate and lower heart rate variability compared with healthy controls in a sample that was sufficiently powered to examine the confounding effects of lifestyle and antidepressants. Methods: The standard deviation of the normal-to-normal intervals (SDNN), heart rate (HR), and respiratory sinus arrhythmia (RSA) were measured in 2059 subjects (mean age = 41.7 years, 66.8% female) participating in The Netherlands Study of Depression and Anxiety (NESDA). Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Composite International Diagnostic Interview (CIDI), NESDA participants were classified as healthy controls (n = 616), subjects with an anxiety diagnosis earlier in life (n = 420), and subjects with current anxiety diagnosis (n = 1059). Results: Current anxious subjects had a significantly lower SDNN and RSA compared with controls. RSA was also significantly lower in remitted anxious subjects compared with controls. These associations were similar across the three different types of anxiety disorders. Adjustment for lifestyle had little impact. However, additional adjustment for antidepressant use reduced all significant associations between anxiety and HRV to nonsignificant. Anxious subjects who used a tricyclic antidepressant, a selective serotonin reuptake inhibitor, or another antidepressant showed significantly lower mean SDNN and RSA compared with controls (effect sizes = 0.20–0.80 for SDNN and 0.42–0.79 for RSA). Nonmedicated anxious subjects did not differ from controls in mean SDNN and RSA. Conclusion: This study shows that anxiety disorders are associated with significantly lower HR variability, but the association seems to be driven by the effects of antidepressants. ANOVA = analysis of variance; ANS = autonomic nervous system; ATC = anatomical therapeutic chemical; BAI = Beck Anxiety Inventory; BMI = body mass index; CIDI = Composite International Diagnostic Interview; CVD = cardiovascular disease; dZ = changes in thorax impedance; ECG = electrocardiogram; GAD = generalized anxiety disorder; HR = heart rate; HRV = heart rate variability; IBI = inter-beat-interval; MDD = major depressive disorder; MET = multiple of one's resting metabolic rate times minutes of physical activity; NESDA = The Netherlands Study of Depression and Anxiety; PD = panic disorder; pv = peak-valley; PNS = parasympathetic nervous system; RR = respiratory rate; RSA = respiratory sinus arrhythmia; SDNN = standard deviation of the normal-to-normal interval; SNS = sympathetic nervous system; SP = social phobia; VU-AMS = Vrije Universiteit Ambulatory Monitoring System; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.
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“A study involving 616 controls and 1,479 adults with anxiety showed that lower RSA in anxious subjects (52.1 vs. 45.1 ms; peak–valley method) survived adjustment for possible confounding factors as health indicators and lifestyle, but further adjustment for antidepressant use rendered all associations non-significant (62).”
From Autism Spectrum Disorder in Children Is Not Associated With Abnormal Autonomic Nervous System Function: Hypothesis and Theory (2022) · cites this paper as [62]
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In the citing paper
“Hence, drug use is a critical factor affecting HRV.”
From Autism Spectrum Disorder in Children Is Not Associated With Abnormal Autonomic Nervous System Function: Hypothesis and Theory (2022) · cites this paper as [62]
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“the latter can be easily conceptualized as a chronic psychobiological stress response in the absence of realistic stressors”
From Exposed to events that never happen: generalized unsafety, the default stress response, and prolonged autonomic activity (2017) · cites this paper as Licht et al., 2009
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“PC is not only a core element chronic stress, but also in chronic anxiety”
From Exposed to events that never happen: generalized unsafety, the default stress response, and prolonged autonomic activity (2017) · cites this paper as Licht et al., 2009
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“Interestingly, in another common condition in which the social network is compromised, that is social anxiety, chronic low HRV has been reported (e.g.Licht et al., 2009).”
From Exposed to events that never happen: generalized unsafety, the default stress response, and prolonged autonomic activity (2017) · cites this paper as Licht et al., 2009
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Metadata
- Authors
- Licht, C. M. M., de Geus, E. J. C., van Dyck, R., & Penninx, B. W. J. H.
- Affiliations
- Amsterdam Public Health (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Licht, Carmilla M. M.
- Venue
- Psychosomatic Medicine
- Published
- 2009-06
- Volume
- 71
- Issue
- 5
- Pages
- 508-518
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2111743880
- Cited by
- 215
- References
- 69
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 14 · 2023: 10 · 2022: 7 · 2021: 19 · 2020: 11 · 2019: 12 · 2018: 14 · 2017: 10 · 2016: 21 · 2015: 12 · 2014: 14 · 2013: 20 · 2012: 18
- FWCI
- 8.44
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- VU Research Portal (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Vrije Universiteit Amsterdam
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (10-000-1002, Grant 10-000-1002)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- anxiety disorders, heart rate variability, respiratory sinus arrhythmia, panic disorder, social anxiety disorder, generalized anxiety disorder, tricyclic antidepressants, selective serotonin reuptake inhibitors, autonomic nervous system, heart rate, lifestyle confounding, NESDA, cardiovascular risk, comorbid depression
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Anxiety Disorders, Arrhythmias, Cardiac, Arrhythmia, Sinus, Cross-Sectional Studies, Depressive Disorder, Major, Major Depressive Disorder, Electrocardiography, Female, Health Status, Heart Rate, Humans, Male, Middle Aged, Netherlands, Phobic Disorders, Psychiatric Status Rating Scales, Surveys and Questionnaires, Respiration, Risk Factors, Severity of Illness Index, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders
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