Heart Rate Variability Predicts Treatment Outcome in Major Depression
Open accessAbstract
Aims: Autonomic nervous system (ANS) dysregulation is associated with various symptoms of depressive disorder. The beat-to-beat pattern of heart rate (Heart Rate Variability) (HRV) provides a noninvasive portal to ANS function through the quantification of periodic heart rate patterns. In this study we quantified two components of HRV: Respiratory Sinus Arrhythmia (RSA), and Low Frequency HRV (LF-HRV). Both of these components have been extensively reported in studies of depression and have been at least partially associated with reduction in vagal nerve tone. We quantified RSA and LF-HRV in patients with Major Depressive Disorder (MDD) as measures of ANS regulation seeking to establish the utility of components of HRV as potential diagnostic and prognostic biomarkers for treatment outcome. Methods: Sixty-six MDD patients were enrolled. In two separate and consecutively run studies they received either Escitalopram or Quetiapine fumarate ER over 12 weeks. Forty-one patients completed the studies. RSA and LF-HRV were assessed at pretreatment and end of study. Thirty-six healthy subjects served as controls. RSA and LF-HRV were quantified using an algorithm that incorporates time and frequency domains to address the non-stationarity of the beat-to-beat heart rate pattern. Results: No significant differences in baseline RSA or LF-HRV were found between MDD and healthy controls. However, baseline RSA and LF-HRV were significantly higher in treatment responders (lnRSA = 6.20, lnLF-HRV = 5.76) than non-responders (lnRSA = 4.75, lnLF-HRV = 4.53) (p = 0.005, p = 0.006). No significant changes in RSA or LF-HRV were detected over the course of either treatment. Conclusions: Components of HRV may be predictive of antidepressant response in MDD patients.
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Baseline or non-challenge level RSA and other metrics of heart rate variability are related to mental health outcomes, with higher values usually associated with more positive outcomes and greater resilience.
“There is a large literature documenting the baseline or non-challenge level RSA and other metrics of heart rate variability are related to mental health outcomes with higher values usually being associated with more positive outcomes and greater resilience (See Ref. [62]).”
From The vagal paradox: A polyvagal solution (2023) · cites this paper as [62]
The Results and Discussion report that patients with major depression who responded to antidepressant treatment had higher baseline RSA and LF-HRV than nonresponders. This supports a link between higher baseline HRV and a better treatment outcome, but the paper does not establish the broader claim about mental health outcomes generally or greater resilience. The Results also found no significant baseline difference between patients with depression and healthy controls. (LLM, conf=0.85)
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- Authors
- Hage, B., Sinacore, J. M., Heilman, K. J., Porges, S. W., & Halaris, A. E.
- Affiliations
- Loyola University Chicago (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Angelos E Halaris
- Venue
- Journal of Psychiatry and Brain Science
- Publisher
- Hapres
- Published
- 2017-12-25
- ISSN
- 2398-385X (ISSN-L)
- OpenAlex
- W2954543930
- Cited by
- 13
- References
- 49
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 2
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Journal of Psychiatry and Brain Science (publishedVersion, cc-by)
- Funders
- Loyola University Chicago Stritch School of Medicine
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- heart rate variability, major depressive disorder, antidepressant response, respiratory sinus arrhythmia, low-frequency HRV, autonomic dysfunction, escitalopram, quetiapine, prognostic factors, treatment outcome prediction
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