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Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis
Open accessAbstract
Background: Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. Methods: We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. Results: In total, 140 case–control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = −0.583) with a large effect for psychotic disorders (Hedges g = −0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. Limitations: Study quality significantly moderated effect sizes in case–control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. Conclusion: Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.
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“Low resting-state vagal modulation/parasympathetic activity is also observed in a variety of other psychiatric conditions, such as mood disorders, anxiety disorders and autism spectrum disorder30,45.”
From Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health (2021) · cites this paper as [30]
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“ANS function is purportedly modulated by the core-ICNs and one of the most robust ANS disturbances found in IDs is cardiac dysautonomia in the form of reduced HRV [52, 96, 103, 280, 282–293].”
From Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders (2022) · cites this paper as [52]
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“It is also noteworthy to add that autonomic dysfunction is a characteristic feature of other psychiatric illnesses, such as anxiety and mood disorders; however, it appears that autonomic dysfunction is greatest in psychotic disorders30.”
From Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health (2021) · cites this paper as [30]
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“possibly helping to explain the ANS dysfunction consistently reported across psychopathologies [51, 52].”
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“This has significant clinical implications considering that cardiovascular disease is the leading cause of mortality in people with mental illness [52, 294, 295].”
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Items 201–256 of 256
Akar, S. A., Kara, S., Latifoğlu, F., & Bilgiç, V. (2015) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-014-9580-8 · Cited by 35
Chung, M.-S., Yang, A. C., Lin, Y.-C., Lin, C.-N., Chang, F.-R., Shen, S.-H., Ouyang, W.-C., Loh, E.-W., & Chiu, H.-J. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.07.034 · Cited by 34
Heart rate variability in the subsyndromal depressive phase of bipolar disorder
Lee, J., Kim, B., Hong, Y., & Joo, Y. H. (2012) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2012.02335.x · Cited by 33
Kubo, T., Parker, J. D., Azevedo, E. R., Atchison, D. J., Newton, G. E., Picton, P. E., & Floras, J. S. (2005) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2004.10.012 · Cited by 33
Jáuregui, O. I., Costanzo, E. Y., de Achával, D., Villarreal, M. F., Chu, E., Mora, M. C., Vigo, D. E., Castro, M. N., Leiguarda, R. C., Bär, K.-J., et al. (2011) · Cognitive and Behavioral Neurology · doi:10.1097/wnn.0b013e31824007e9 · Cited by 33
Heart rate correlates of utilitarian moral decision-making in alcoholism
Carmona-Perera, M., del Paso, G. A. R., Pérez-Garcı́a, M., & Verdejo‐García, A. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.06.023 · Cited by 31
Sex differences in cardiac autonomic function of depressed young adults
Garcia, R. G., Zarruk, J. G., Guzmán, J. C., Barrera, C., Pinzón, A., Trillos, E., López-Jaramillo, P. A., Morillo, C. A., Maior, R. S., Díaz-Quijano, F. A., et al. (2012) · Biological Psychology · doi:10.1016/j.biopsycho.2012.03.016 · Cited by 31
Panic disorder, autonomic nervous system and dissociation - changes during therapy.
Praško, J. P., Látalová, K., Diveky, T., Grambal, A., Kamarádová, D., Velartova, H., Salinger, J., Opavsky, J., & Šilhán, P. (2011) · PubMed · Cited by 31
Cardiac autonomic dysregulation in acute schizophrenia
Chang, H.-A., Chang, C.-C., Tzeng, N.-S., Kuo, T. B. J., Lu, R.-B., & Huang, S.-Y. (2013) · Acta Neuropsychiatrica · doi:10.1111/acn.12014 · Cited by 30
Scott, E. M., Hermens, D. F., White, D., Naismith, S. L., Gehue, J., Whitwell, B. G., Glozier, N., & Hickie, I. B. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007066 · Cited by 29
Self-citationFisher, A. J., & Woodward, S. H. (2013) · Psychophysiology · doi:10.1111/psyp.12148 · Cited by 27
Heart Rate Variability in Depressed Patients
Sayar, K., Güleç, H., Gökçe, M., & Ak, İ. (2002) · Psychiatry and Clinical Psychopharmacology · Cited by 26
Chang, H., Chang, C.-C., Tzeng, N., Kuo, T. B. J., Lu, R., & Huang, S. (2013) · Asia-Pacific Psychiatry · doi:10.1111/appy.12032 · Cited by 26
Influence of age on the parasympatholytic property of tricyclic antidepressants
Lehofer, M., Moser, M., Hoehn‐Saric, R., McLeod, D. R., Hildebrandt, G., Egner, S., Steinbrenner, B., Liebmann, P. M., & Zapotoczky, H. G. (1999) · Psychiatry Research · doi:10.1016/s0165-1781(99)00005-0 · Cited by 26
Yeragani, V. K., Srinivasan, K., Pohl, R. B., Berger, R. D., Balon, R., & Ramesh, C. (2008) · Neuropsychobiology · doi:10.1159/000119054 · Cited by 25
Agelink, M. W., Ullrich, H., Baumann, B., Strum, S., & Majewski, T. (2002) · Psychopharmacology · doi:10.1007/s00213-002-1146-7 · Cited by 25
The relation of autonomic function to physical fitness in patients suffering from alcohol dependence
Herbsleb, M., Schulz, S., Ostermann, S., Donath, L., Eisenträger, D., Puta, C., Voss, A., Gabriel, H. W., & Bär, K. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.03.016 · Cited by 24
Relationship between heart rate variability and the severity of psychotic symptoms in schizophrenia
Kim, J.-H., Ann, J.-H., & Lee, J. (2011) · Acta Neuropsychiatrica · doi:10.1111/j.1601-5215.2011.00549.x · Cited by 24
Wang, J., Liu, Y., Zhu, W., Zhang, F., & Zhou, Z. (2014) · Scientific Reports · doi:10.1038/srep07394 · Cited by 24
Yeragani, V. K., Mallavarapu, M., Radhakrishna, R. K. A., Tancer, M. E., & Uhde, T. W. (2004) · Depression and Anxiety · doi:10.1002/da.10129 · Cited by 24
Differences between heart rate and blood pressure variability in schizophrenia
Bär, K., Boettger, M. K., & Voss, A. (2006) · Biomedizinische Technik/Biomedical Engineering · doi:10.1515/bmt.2006.045 · Cited by 23
Wang, Y.-C., Yang, C. C. H., Bai, Y., & Kuo, T. B. J. (2008) · Neuropsychobiology · doi:10.1159/000149818 · Cited by 23
Heart Rate Variability and Omega-3 Index in Euthymic Patients with Bipolar Disorders
Voggt, A., Berger, M., Obermeier, M., Löw, A., Seemüller, F., Riedel, M. J., Moeller, H. –., Zimmermann, R., Kirchberg, F. F., von Schacky, C., et al. (2014) · European Psychiatry · doi:10.1016/j.eurpsy.2014.11.010 · Cited by 23
Platelet Serotonin Transporter Function and Heart Rate Variability in Patients with Panic Disorder
Kang, E., Lee, I.-S., Park, J. E., Kim, K.-J., & Yu, B. (2010) · Journal of Korean Medical Science · doi:10.3346/jkms.2010.25.4.613 · Cited by 22
Chang, L., Lin, Y., Kuo, T. B. J., Chang, H.-C. W., Liu, C., Liu, C., Hwu, H., & Yang, C. C. H. (2011) · PLoS ONE · doi:10.1371/journal.pone.0026378 · Cited by 22
Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women
Albert, C. M., Chae, C. U., & Rexrode, K. M. (2005) · ACC Current Journal Review · doi:10.1016/j.accreview.2005.05.027 · Cited by 22
Diveky, T., Praško, J. P., Látalová, K., Grambal, A., Kamarádová, D., Šilhán, P., Obereignerů, R., Salinger, J., Opavsky, J., & Tonhajzerová, I. (2012) · PubMed · Cited by 21
Illness severity, trait anxiety, cognitive impairment and heart rate variability in bipolar disorder
Levy, B. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.07.059 · Cited by 21
Reduced cardio-respiratory coupling after treatment with nortriptyline in contrast to S-citalopram
Bär, K., Schuhmacher, A., Höfels, S., Schulz, S., Voss, A., Yeragani, V. K., Maier, W., & Zobel, A. W. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.05.010 · Cited by 21
Chang, J. S., Ha, K., Yoon, I., Yoo, C. S., Yi, S. H., Her, J. Y., Ha, T. H., & Park, T. (2012) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2012.06.002 · Cited by 19
Cardiac autonomic modulation during methadone therapy among heroin users: A pilot study
Chang, L., Lin, Y., Kuo, T. B. J., Ho, Y.-C., Chen, S.-H., Chang, H.-C. W., Liu, C., & Yang, C. C. H. (2012) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2012.01.006 · Cited by 19
Rechlin, T., Claus, D., Weis, M., & Wp, K. (1995) · European Psychiatry · doi:10.1016/0767-399x(96)80063-0 · Cited by 18
Depression, antidepressant treatment and the cardiovascular system
Kemp, A. H. (2011) · Acta Neuropsychiatrica · doi:10.1111/j.1601-5215.2011.00535.x · Cited by 18
Wang, S., Yeon, B., Hwang, S., Lee, H., Kweon, Y., Lee, C. T., Chae, J., & Lee, K. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.06.001 · Cited by 17
IMPROVED AUTONOMIC NEUROCARDIAL BALANCE IN SHORT-TERM ABSTINENT ALCOHOLICS TREATED WITH ACAMPROSATE
Agelink, M. W., Lemmer, W., Malessa, R., Zeit, T., Majewski, T., & Klieser, E. (1998) · Alcohol and Alcoholism · doi:10.1093/alcalc/33.6.602 · Cited by 17
McLeod, D. R., Hoehn‐Saric, R., Porges, S. W., Kowalski, P. A., & Clark, C. M. (2000) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200012000-00006 · Cited by 17
Kim, J., Yi, S. H., Lee, J.-Y., & Kim, Y. S. (2012) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e31827d14e3 · Cited by 16
Autonomic modulation in healthy first-degree relatives of patients with major depressive disorder
Berger, S., Schulz, S., Kletta, C., Voss, A., & Bär, K. (2011) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2011.05.018 · Cited by 16
Tiling, R., Keßler, M., Untch, M., Sommer, H., Linke, R., Brinkbäumer, K., & Hahn, K. M. (2003) · Oncology Research and Treatment · doi:10.1159/000069860 · Cited by 15
Depression, anxiety, and heart rate variability: A case-control study in Taiwan
Chang, H., Chen, L., Chang, C.-C., Tzeng, N., Kuo, T. B. J., Kao, Y., & Huang, S. (2014) · Journal of Medical Sciences · doi:10.4103/1011-4564.129383 · Cited by 15
Jiang, X., Zhang, Z., Chen, Y., Ye, C.-P., Lei, Y., Wu, L., Zhang, Y., & Xiao, Z. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.009 · Cited by 14
Kim, J., Yi, S. H., Ahn, Y. M., Lee, K. Y., Yang, S. A., & Kim, Y. S. (2009) · Psychiatry Investigation · doi:10.4306/pi.2009.6.4.294 · Cited by 13
Alcohol Consumption, Alcohol Dependence, and All-Cause Mortality
Dawson, D. A. (2000) · Alcoholism Clinical and Experimental Research · doi:10.1097/00000374-200001000-00012 · Cited by 13
Yeragani, V. K., & Kumar, H. V. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00185-9 · Cited by 11
Social cognition and functional outcome in schizophrenia: The moderating role of cardiac vagal tone.
Hamilton, H., Sun, J. C., Green, M. F., Kee, K. S., Lee, J., Sergi, M. J., Sholty, G. L., Mathis, K. I., Jetton, C., Williams, T. J., et al. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0037813 · Cited by 11
In vivo cardiovascular effects of the new atypical neuroleptic sertindole
Agelink, T. Z. M. W. (2001) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/136515001300225178 · Cited by 9
Voss, A., Schulz, S., & Baer, K.-J. (2010) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/iembs.2010.5626479 · Cited by 8
Sudden death in psychiatric patients
Holland, M., & Holland, W. W. (1998) · The British Journal of Psychiatry · doi:10.1192/bjp.173.3.270b · Cited by 7
Alcohol dependence syndrome: Postural challenge on heart rate variability
Srinivasan, K., Sucharita, S., Ruben, J. P., Vincent, A., & Vaz, M. (2012) · Indian Journal of Psychiatry · doi:10.4103/0019-5545.102426 · Cited by 7
Changes in heart rate variability during TOVA testing in patients with major depressive disorder
Shen, T., Liu, F., Chen, S., & Chen, S. (2013) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2012.02404.x · Cited by 6
Paternal age related schizophrenia and cardiac autonomic regulation profiles
Antonius, D., Kimhy, D., Harkavy‐Friedman, J., Crystal, S., Goetz, R. R., & Malaspina, D. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2010.10.007 · Cited by 6
Heart rate variability responses to standing are attenuated in drug naive depressed patients.
Pradeep, J., Sambashivaiah, S., Thomas, T. S., Radhakrishnan, R., Vaz, M. A. P., & Srinivasan, K. (2012) · PubMed · Cited by 6
Cardiac Responses during Picture Viewing in Young Male Patients with Schizophrenia
Hempel, R., Thayer, J. F., Röder, C. H., van Steenis, H. G., van Beveren, N. J. M., & Tulen, J. H. M. (2012) · Cardiovascular Psychiatry and Neurology · doi:10.1155/2012/858562 · Cited by 5
Kim, J., Lee, Kim, Han, & Ann, J.-H. (2013) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s48701 · Cited by 4
Behavioral Stress and Cardiac Arrhythmias
Verrier, R. L. (1984) · Annual Review of Physiology · doi:10.1146/annurev.physiol.46.1.155 · Cited by 4
Kim, J. H., Ann, J.-H., Lee, J., Kim, M. H., & Han, A. Y. (2013) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 1
Research works printed but not linked: 12
- Dawson DA, 2000, Alcohol Clin Exp Res, 24, 72
- Kinugawa T, 1995, Am J Physiol, 268, R310
- Quintana DS, 2013, Alcohol Clin Exp Res, 37, E23, 10.1111/j.1530-0277.2012.01888.x · DOI
- McGorry PD, 2007, Med J Aust, 187, S40, 10.5694/j.1326-5377.2007.tb01113.x · DOI
- Shadish WR, 1994, The handbook of research synthesis, 261
- Diveky T, 2012, Neuroendocrinol Lett, 33, 156
- Prasko J, 2011, Neuroendocrinol Lett, 32, 641
- Pradeep J, 2012, Indian J Physiol Pharmacol, 56, 213
- Sayar K, 2002, Bull Clin Psychopharmacol, 12, 130
- Voss A, 2010, Conf Proc IEEE Eng Med Biol Soc, 2010, 5395
- Nagpal M, 2013, J Trauma Treat, 3, 2167
- Tulen JHM, 1996, J Clin Psychopharmacol, 16, 135, 10.1097/00004714-199604000-00006 · DOI
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Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., Salum, G. A., & Schuch, F. B. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2016.12.020 · Cited by 666
Quintana, D. S., Alvares, G. A., & Heathers, J. A. J. (2016) · Translational Psychiatry · doi:10.1038/tp.2016.73 · Cited by 420
Self-citationDevelopment of the short version of the spielberger state—trait anxiety inventory
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Valstad, M., Alvares, G. A., Egknud, M., Matziorinis, A. M., Andreassen, O. A., Westlye, L. T., & Quintana, D. S. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.04.017 · Cited by 277
“This tool was developed by adapting the tool used in another meta-analysis (33) to”
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Metadata
- Authors
- Alvares, G. A., Quintana, D. S., Hickie, I. B., & Guastella, A. J.
- Affiliations
- Oslo University Hospital (NO)
- Venue
- Journal of Psychiatry and Neuroscience
- Publisher
- Canadian Science Publishing
- Published
- 2016-03
- Volume
- 41
- Issue
- 2
- Pages
- 89-104
- ISSN
- 1180-4882 (ISSN-L)
- 1488-2434
- PMC
- PMC4764485
- OpenAlex
- W2419517449
- Cited by
- 503
- References
- 257
- Citations by year
- 2026: 43 · 2025: 62 · 2024: 53 · 2023: 66 · 2022: 53 · 2021: 61 · 2020: 43 · 2019: 37 · 2018: 36 · 2017: 29 · 2016: 16
- FWCI
- 6.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Psychiatry and Neuroscience (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- UWA Profiles and Research Repository (UWA) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- 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
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- autonomic dysfunction, heart rate variability, mental illness, psychotropic drugs, cardiovascular risk, antidepressants, antipsychotic drugs, psychosis, mood disorders, anxiety disorders, substance use disorders
- MeSH terms
- Autonomic Nervous System Diseases, Mental Disorders, Humans, Psychotropic Drugs
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