Effects of antidepressant treatment on heart rate variability in major depression: A quantitative review

Katsutaro Nagata,Takuya Hasegawa,Louis T Van Zyl

doi:10.1186/1751-0759-2-12

Abstract

BackgroundThe literature measuring effects of antidepressant and electroconvulsive therapy (ECT) for major depression on heart rate variability (HRV) in medically well individuals was reviewed.MethodsFourteen studies evaluating HRV were included. Twenty three pre-post or within group comparisons were available. Treatment impact on measures of HRV was pooled over studies. We examined different classes of antidepressants, and for short and long electrocardiogram (ECG) recordings separately.ResultsTricyclic antidepressants (TCAs) were associated with declines in most measures of HRV and significant increase in heart rate (HR) in studies with short recording intervals. No significant changes were found for longer recording times.Treatment effects with selective serotonin reuptake inhibitors (SSRIs) were more variable. Short-recording studies revealed a significant decrease in HR and an increase in one HRV measure. In two 24-hour recording studies no significant changes were observed. No relationship between ECT and HRV has been established in the literature. The effects of other drugs are reported.LimitationsFew studies measure the effects of treatment of depression on HRV. Existing studies have generally used very small samples, employing a variety of measurements and methodologies.ConclusionWe confirm that TCAs are associated with a large decrease in HRV and increase HR. However, data for SSRIs is not clear. Although the effect of SSRIs on HRV is weaker than for TCAs, evidence shows that SSRIs are associated with a small decrease in HR, and an increase in one measure of HRV. The use of TCAs in depression leads to changes in HRV that are associated with increased risk of mortality.

Highlights

The literature measuring effects of antidepressant and electroconvulsive therapy (ECT) for major depression on heart rate variability (HRV) in medically well individuals was reviewed
The effect of selective serotonin reuptake inhibitors (SSRIs) on HRV is weaker than for tricyclic antidepressants (TCAs), evidence shows that SSRIs are associated with a small decrease in HR, and an increase in one measure of HRV
The use of TCAs in depression leads to changes in HRV that are associated with increased risk of mortality

Summary

Introduction

The literature measuring effects of antidepressant and electroconvulsive therapy (ECT) for major depression on heart rate variability (HRV) in medically well individuals was reviewed. Studies have shown that depression is associated with a higher rate of development of coronary heart disease and of death after an index myocardial infarction (MI) [10], and that a low HRV after MI is associated with considerable risk of mortality [2,11,12,13,14] As a result there has been substantial interest in the relationship of HRV with depression and with antidepressant medications. The purpose of the current paper is to provide an overview of the literature examining the effects of pharmacologic and physical treatments for depression on HRV in medically otherwise well patients with MDD. We review the small group of studies examining the effects of other antidepressants on HRV, as well as the effects of electroconvulsive therapy (ECT)

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