title: The association between depressive disorder and cardiac autonomic control in adults 60 years and older.
abstract: BACKGROUND
  Altered cardiac autonomic control has often been reported in depressed persons and might play an important role in the increased risk for cardiovascular disease (CVD). A negative association between cardiac autonomic control and depression might become specifically clinically relevant in persons 60 years or older as CVD risk increases with age.
  
  
  METHODS
  This study included data of 321 persons with a depressive disorder and 115 controls participating in the Netherlands Study of Depression in Older Persons (mean age = 70.3 years, 65.7% female). Respiratory sinus arrhythmia (RSA), heart rate (HR), and preejection period (PEP) were measured and compared between depressed persons and controls. In addition, the role of antidepressants and clinical characteristics (e.g., age of depression onset and comorbid anxiety) was examined.
  
  
  RESULTS
  Compared with controls, depressed persons had lower RSA (mean [standard error of the mean] = 23.5 [1.2] milliseconds versus 18.6 [0.7] milliseconds, p = .001, d = 0.373) and marginally higher HR (73.1 [1.1] beats/min versus 75.6 [0.6] beats/min, p = .065, d = 0.212), but comparable PEP (113.9 [2.1] milliseconds versus 112.0 [1.2] milliseconds, p = .45, d = 0.087), fully adjusted. Antidepressants strongly attenuated the associations between depression and HR and RSA. Antidepressant-naïve depressed persons had similar HR and RSA to controls, whereas users of antidepressants showed significantly lower RSA. In addition, tricyclic antidepressant users had higher HR (p < .001, d = 0.768) and shorter PEP (p = .014, d = 0.395) than did controls.
  
  
  CONCLUSIONS
  Depression was not associated with cardiac autonomic control, but antidepressants were in this sample. All antidepressants were associated with low cardiac parasympathetic control and specifically tricyclic antidepressants with high cardiac sympathetic control.
authors.affiliation: From the GGZinGeest/Department of Psychiatry (Licht, Penninx, Comijs) and EMGO+ Institute (Licht, Penninx, de Geus, Comijs), VU University Medical Center, Amsterdam, the Netherlands; Department of Old-Age Psychiatry (Naarding), GGNet, Apeldoorn/Zutphen, the Netherlands; Department of Psychiatry (van der Mast), Leiden University Medical Center, Leiden, the Netherlands; and Department of Biological Psychology (de Geus), VU University, Amsterdam, the Netherlands.
authors.forename: Carmilla M M
authors.initials: CM
authors.lastname: Licht
authors.forename: Paul
authors.initials: P
authors.lastname: Naarding
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
authors.forename: Roos C
authors.initials: RC
authors.lastname: van der Mast
authors.forename: Eco J C
authors.initials: EJ
authors.lastname: de Geus
authors.forename: Hannie
authors.initials: H
authors.lastname: Comijs
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D002307:Cardiography, Impedance; D016022:Case-Control Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D065809:Respiratory Sinus Arrhythmia / Q000502:physiology*