Depression, the Autonomic Nervous System, and Coronary Heart Disease

Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 05/2005; 67 Suppl 1(supplement 1):S29-33. DOI: 10.1097/01.psy.0000162254.61556.d5
Source: PubMed


Depression is a risk factor for medical morbidity and mortality in patients with coronary heart disease (CHD). Dysregulation of the autonomic nervous system (ANS) may explain why depressed patients are at increased risk. Studies of medically well, depressed psychiatric patients have found elevated levels of plasma catecholamines and other markers of altered ANS function compared with controls. Studies of depressed patients with CHD have also uncovered evidence of ANS dysfunction, including elevated heart rate, low heart rate variability, exaggerated heart rate responses to physical stressors, high variability in ventricular repolarization, and low baroreceptor sensitivity. All of these indicators of ANS dysfunction have been associated with increased risks of mortality and cardiac morbidity in patients with CHD. Further research is needed to determine whether ANS dysfunction mediates the effects of depression on the course and outcome of CHD, and to develop clinical interventions that improve cardiovascular autonomic regulation while relieving depression in patients with CHD.
ANS = autonomic nervous system; CHD = coronary heart disease; HRV = heart rate variability; MI = myocardial infarction; NE = norepinephrine; SNS = sympathetic nervous system.

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Article: Depression, the Autonomic Nervous System, and Coronary Heart Disease

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    • "While a variety of mechanisms – both genetic and behavioral – have been proposed to explain this association, one specific pathophysiological mechanism through which depression is thought to increase cardiac risk is a dysregulation of the autonomic neural control of cardiac function. For example, depressive patients have been found to display a predominance of sympathoadrenergic activation and/or reduced parasympathetic modulation, as evidenced by increases in restingstate heart rate (HR) and decreases in its variability (HRV) (Udupa et al., 2007), both predictive of adverse cardiovascular events (Carney et al., 2005). However, other studies have reported contradictory findings, leading to significant debate and discussion as to whether depression per se is associated with reduced HRV or, rather, autonomic dysfunction is a consequence of pharmacological antidepressant treatment (Licht et al., 2010; Kemp et al., 2014). "
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