title: Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis.
abstract: BACKGROUND
  Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use.
  
  
  METHODS
  We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication.
  
  
  RESULTS
  In total, 140 case-control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = -0.583) with a large effect for psychotic disorders (Hedges g = -0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics.
  
  
  CONCLUSIONS
  Study quality significantly moderated effect sizes in case-control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings.
  
  
  CONCLUSIONS
  Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.
authors.affiliation: From the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).
authors.forename: Gail A
authors.initials: GA
authors.lastname: Alvares
authors.affiliation: From the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Quintana
authors.affiliation: From the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).
authors.forename: Ian B
authors.initials: IB
authors.lastname: Hickie
authors.affiliation: From the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Guastella
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D001523:Mental Disorders / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs