title: Heart rate variability is a trait marker of major depressive disorder: evidence from the sertraline vs. electric current therapy to treat depression clinical study.
abstract: Decreased heart rate variability (HRV) is a cardiovascular predictor of mortality. Recent debate has focused on whether reductions in HRV in major depressive disorder (MDD) are a consequence of the disorder or a consequence of pharmacotherapy. Here we report on the impact of transcranial direct current stimulation (tDCS), a non-pharmacological intervention, vs. sertraline to further investigate this issue. The employed design was a double-blind, randomized, factorial, placebo-controlled trial. One hundred and eighteen moderate-to-severe, medication-free, low-cardiovascular risk depressed patients were recruited for this study and allocated to either active/sham tDCS (10 consecutive sessions plus two extra sessions every other week) or placebo/sertraline (50 mg/d) for 6 wk. Patients were age and gender-matched to healthy controls from a concurrent cohort study [the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)]. The impact of disorder, treatment and clinical response on HRV (root mean square of successive differences and high frequency) was examined. Our findings confirmed that patients displayed decreased HRV relative to controls. Furthermore, HRV scores did not change following treatment with either a non-pharmacological (tDCS) or pharmacological (sertraline) intervention, nor did HRV increase with clinical response to treatment. Based on these findings, we discuss whether reduced HRV is a trait-marker for MDD, which may predispose patients to a host of conditions and disease even after response to treatment. Our findings have important implications for our understanding of depression pathophysiology and the relationship between MDD, cardiovascular disorders and mortality.
authors.affiliation: Clinical Research Center, University Hospital, University of São Paulo, SP, Brazil.
authors.forename: Andre Russowsky
authors.initials: AR
authors.lastname: Brunoni
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kemp
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Dantas
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Goulart
authors.forename: Maria Angélica
authors.initials: MA
authors.lastname: Nunes
authors.forename: Paulo S
authors.initials: PS
authors.lastname: Boggio
authors.forename: José Geraldo
authors.initials: JG
authors.lastname: Mill
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001938:Brazil; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline