Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety (NESDA).
OBJECTIVE
To determine whether patients with different types of anxiety disorder (panic disorder, social phobia, generalized anxiety disorder) have higher heart rate and lower heart rate variability compared with healthy controls in a sample that was sufficiently powered to examine the confounding effects of lifestyle and antidepressants.


METHODS
The standard deviation of the normal-to-normal intervals (SDNN), heart rate (HR), and respiratory sinus arrhythmia (RSA) were measured in 2059 subjects (mean age = 41.7 years, 66.8% female) participating in The Netherlands Study of Depression and Anxiety (NESDA). Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Composite International Diagnostic Interview (CIDI), NESDA participants were classified as healthy controls (n = 616), subjects with an anxiety diagnosis earlier in life (n = 420), and subjects with current anxiety diagnosis (n = 1059).


RESULTS
Current anxious subjects had a significantly lower SDNN and RSA compared with controls. RSA was also significantly lower in remitted anxious subjects compared with controls. These associations were similar across the three different types of anxiety disorders. Adjustment for lifestyle had little impact. However, additional adjustment for antidepressant use reduced all significant associations between anxiety and HRV to nonsignificant. Anxious subjects who used a tricyclic antidepressant, a selective serotonin reuptake inhibitor, or another antidepressant showed significantly lower mean SDNN and RSA compared with controls (effect sizes = 0.20-0.80 for SDNN and 0.42-0.79 for RSA). Nonmedicated anxious subjects did not differ from controls in mean SDNN and RSA.


CONCLUSIONS
This study shows that anxiety disorders are associated with significantly lower HR variability, but the association seems to be driven by the effects of antidepressants.
Department of Psychiatry, EMGO Institute, VU University Medical Center, AJ Ernststraat 887, 1081 HL, Amsterdam, The Netherlands. C.Licht@vumc.nl
Carmilla M M
CM
Licht
Eco J C
EJ
de Geus
Richard
R
van Dyck
Brenda W J H
BW
Penninx
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001146:Arrhythmia, Sinus / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004562:Electrocardiography; D005260:Female; D006304:Health Status; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010698:Phobic Disorders / Q000188:drug therapy; D011569:Psychiatric Status Rating Scales; D012119:Respiration; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents