title: Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression.
abstract: Major depressive disorder (MDD) is a common mood disorder that can result in significant discomfort as well as interpersonal and functional disability. A growing body of research indicates that autonomic function is altered in depression, as evidenced by impaired baroreflex sensitivity, changes in heart rate, and reduced heart rate variability (HRV). Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in participants with MDD, and baroreflex gain is decreased.
  
  
  OBJECTIVE
  To assess the feasibility of using HRV biofeedback to treat major depression.
  
  
  METHODS
  This was an open-label study in which all eleven participants received the treatment condition. Participants attended 10 weekly sessions. Questionnaires and physiological data were collected in an orientation (baseline) session and Treatment Sessions 1, 4, 7 and 10.
  
  
  RESULTS
  Significant improvements were noted in the Hamilton Depression Scale (HAM-D) and the Beck Depression Inventory (BDI-II) by Session 4, with concurrent increases in SDNN, standard deviation of normal cardiac interbeat intervals) an electrocardiographic estimate of overall measure of adaptability. SDNN decreased to baseline levels at the end of treatment and at follow-up, but clinically and statistically significant improvement in depression persisted. Main effects for task and session occurred for low frequency range (LF) and SDNN. Increases in these variables also occurred during breathing at one's resonant frequency, which targets baroreflex function and vagus nerve activity, showing that subjects performed the task correctly.
  
  
  CONCLUSIONS
  HRV biofeedback appears to be a useful adjunctive treatment for the treatment of MDD, associated with large acute increases in HRV and some chronic increases, suggesting increased cardiovagal activity. It is possible that regular exercise of homeostatic reflexes helps depression even when changes in baseline HRV are smaller. A randomized controlled trial is warranted.
authors.affiliation: Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ, USA. karavima@umdnj.edu
authors.forename: Maria Katsamanis
authors.initials: MK
authors.lastname: Karavidas
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lehrer
authors.forename: Evgeny
authors.initials: E
authors.lastname: Vaschillo
authors.forename: Bronya
authors.initials: B
authors.lastname: Vaschillo
authors.forename: Humberto
authors.initials: H
authors.lastname: Marin
authors.forename: Steven
authors.initials: S
authors.lastname: Buyske
authors.forename: Igor
authors.initials: I
authors.lastname: Malinovsky
authors.forename: Diane
authors.initials: D
authors.lastname: Radvanski
authors.forename: Afton
authors.initials: A
authors.lastname: Hassett
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D001676:Biofeedback, Psychology / Q000502:physiology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D012119:Respiration