title: Nonverbal behaviors are associated with increased vagal activity in major depressive disorder: Implications for the polyvagal theory.
abstract: Major depressive disorder (MDD) is associated with impairments in nonverbal behaviors (NVBs) and vagal activity. The polyvagal theory proposes that vagal activity regulates heart rate and NVBs by modulating a common anatomically and neurophysiologically discrete social engagement system. However, the association between these putative endophenotypes has not yet been explored. We hypothesize that in MDD, NVBs indicating positive affects and social interest and those indicating negative feelings and social disinterest could be associated with different patterns of vagal activity.
  
  
  
  For this cross-sectional study we recruited 50 antidepressant-free participants with moderate-to-severe MDD. Vagal activity was indexed by heart rate variability (HRV) measures, and positive and negative nonverbal behaviors (NVBs) by a validated ethogram. Associations between NVBs and HRV were explored by bivariate analyses and multivariable models were adjusted by age, gender, depression severity, and self-reported positive and negative affects.
  
  
  
  HRV measures indicative of higher vagal activity were positively correlated with positive NVBs exhibited during the clinical interview. Conversely, NVBs related to negative affects, low energy and social disinterest were not associated with HRV.
  
  
  
  Absence of a control group.
  
  
  
  The findings highlight that the examined depression endophenotypes (nonverbal behaviors and vagal activity) are related, shedding light on MDD pathophysiology in the context of the polyvagal theory.
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil.
authors.forename: Raquel A
authors.initials: RA
authors.lastname: Fernandes
authors.affiliation: LIM-23, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
authors.forename: Juliana T
authors.initials: JT
authors.lastname: Fiquer
authors.affiliation: LIM-23, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
authors.forename: Clarice
authors.initials: C
authors.lastname: Gorenstein
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil.
authors.forename: Lais Boralli
authors.initials: LB
authors.lastname: Razza
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil; Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
authors.forename: Renério
authors.initials: R
authors.lastname: Fraguas
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil; Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
authors.forename: Lucas
authors.initials: L
authors.lastname: Borrione
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: Collegiate of Biological Sciences, Federal University of Vale do São Francisco, Petrolina, Brazil.
authors.forename: Eduardo Miranda
authors.initials: EM
authors.lastname: Dantas
authors.affiliation: Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil; Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, São Paulo, Brazil. Electronic address: brunowsky@gmail.com.
authors.forename: André R
authors.initials: AR
authors.lastname: Brunoni
mesh_terms: D000328:Adult; D000339:Affect; D001519:Behavior; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012919:Social Behavior; D014630:Vagus Nerve / Q000503:physiopathology*; D020421:Vagus Nerve Diseases / Q000503:physiopathology* / Q000523:psychology*
keywords: Ethogram; Heart rate variability; Major depressive disorder; Nonverbal behavior; Psychiatry; Vagal activity