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Heart Rate Variability Changes in Elderly Patients with Depression: A Systematic Review

Year 2025, Volume: 17 Issue: 4, 716 - 725

Leyla Aydın , Sena Kabakçı

https://doi.org/10.18863/pgy.1556204

Abstract

Depression is a prevalent and serious mood disorder that affects a person's mood and daily activities, often leading to severe symptoms. Beyond its impact on mood, depression can also dysfunctions in the autonomic nervous system function, particularly in elderly individuals, where such dysfunctions often complicate management and outcomes. Evaluating the autonomic nervous system in those diagnosed with depression is crucial for understanding the disease’s progression. One non-invasive method for quantitatively assessing ANS is the computerized analysis of heart rate variability (HRV). Studies examining HRV changes in individuals with depression have yielded varied results. Although age is known to influence HRV, there is a lack of sufficient studies in the geriatric population. This systematic review aimed to examine HRV changes in elderly individuals diagnosed with depression. Among the 688 studies reviewed from databases including Wiley, Web of Science, Springer Link, Scopus, Science Direct, PubMed, APA PsycArticles and The Networked Digital Library of Theses and Dissertations (NDLTD) databases from 2017 to 10/09/2024, three randomized controlled studies met the inclusion criteria. Our systematic review found that different meditation and exercise programs applied to elderly depression patients may have varying effects on autonomic nervous system and HRV parameters. However, we did not find any study comparing HRV parameters between elderly depression patients and healthy controls, which was the primary focus of our review. This key limitation underscores the significant gap in the existing literature. Given the high prevalence of depression in older age groups, more research is needed in this area.

Keywords

: Heart Rate Variability Depression Geriatric Population

References

  • Agorastos A, Mansueto AC, Hager T, Pappi E, Gardikioti A, Stiedl O (2023) Heart rate variability as a translational dynamic biomarker of altered autonomic function in health and psychiatric disease. Biomedicines, 11:1591.
  • Arantes FS, Rosa Oliveira V, Leão AKM, Afonso JPR, Fonseca AL, Fonseca DRP (2022) Heart rate variability: a biomarker of frailty in older adults? Front Med, 9:1008970.
  • Ayudhaya WSN, Pityaratstian N, Eungpinichpong W, Rattananupong T, Kitidumrongsuk P, Loonlawong S (2022) Effect of behavioral activation on time and frequency domain heart rate variability in older adults with subthreshold depression: a cluster randomized controlled trial in Thailand. BMC Psychiatry, 22:319.
  • Blase KL, van Waning A (2019) Heart rate variability, cortisol, and attention focus during Shamatha quiescence meditation. Appl Psychophysiol Biofeedback, 44:331-342
  • Boztaş MH, Arısoy Ö (2010) Tıbbi hastalıklarda depresyon: tanısal sorunlar. Psikiyatride Güncel Yaklaşımlar, 2:318-332.
  • Brown L, Karmakar C, Gray R, Jindal R, Lim T, Bryant C (2018) Heart rate variability alterations in late life depression: a meta-analysis. J Affect Disord, 1:456-466.
  • Carney RM, Freedland KE (2017) Depression and coronary heart disease. Nat Rev Cardiol, 14:145-155.
  • Chuang HW, Kao CW, Lee MD, Chang YC (2018) Effectiveness of the story-centred care intervention program in older persons living in long-term care facilities: a randomized, longitudinal study. PLoS One, 13:e0194178.
  • Cygankiewicz I, Zareba W (2013) Heart rate variability. Handb Clin Neurol, 117:379-393.
  • Ekers D, Richards D, McMillan D, Bland JM, Gilbody S (2011) Behavioural activation delivered by the non-specialist: phase II randomized controlled trial. Br J Psychiatry, 198:66-72.
  • European Society of Cardiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation, 93:1043-1065.
  • Evans M, Mottram P (2000) Diagnosis of depression in elderly patients. Adv Psychiatr Treat, 6:49-56.
  • Gevirtz RN, Lehrer PM, Schwartz MS (2016) Cardiorespiratory biofeedback. In Biofeedback: A Practitioner’s Guide (Eds MS Schwartz, F Andrasik). New York, Guilford Press.
  • Gilsanz P, Karter AJ, Beeri MS, Quesenberry CP Jr, Whitmer RA (2018) The bidirectional association between depression and severe hypoglycemic and hyperglycemic events in type 1 diabetes. Diabetes Care, 41:446-452.
  • Göçen HB, Özden AV (2024) Autonomic dysfunction in psychiatric disorders. Psikiyatride Güncel Yaklaşımlar, 16:401-409.
  • Goldberger AL (1991) Is the normal heartbeat chaotic or homeostatic? News Physiol Sci, 6:87-91.
  • Grippo AJ, Johnson AK (2002) Biological mechanisms in the relationship between depression and heart disease. Neurosci Biobehav Rev, 26:941-962.
  • Jangpangi D, Mondal S, Bandhu R, Kataria D, Gandhi A (2016) Alteration of heart rate variability in patients with depression. J Clin Diagn Res, 10:CM04-CM06.
  • JBI (2017) The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews:Checklist for Randomized Controlled Trials. https://jbi.global/sites/default/files/2019-05/JBI_RCTs_Appraisal_tool2017_0.pdf (accessed 09/09/2024).
  • Kemp AH, Quintana DS, Gray MA, Felmingham KL, Brown K, Gatt JM (2010) Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry, 67:1067-1074.
  • Kidwell M, Ellenbroek BA (2018) Heart and soul: heart rate variability and major depression. Behav Pharmacol, 29:152-164.
  • Kim W, Lim SK, Chung EJ, Woo JM (2009) The effect of cognitive behavior therapy-based psychotherapy applied in a forest environment on physiological changes and remission of major depressive disorder. Psychiatry Investig, 6:245-254.
  • Koch C, Wilhelm M, Salzmann S, Rief W, Euteneuer F (2019) A meta-analysis of heart rate variability in major depression. Psychol Med, 49:1948-1957.
  • Krishnamoorthy Y, Rajaa S, Rehman T (2020) Diagnostic accuracy of various forms of geriatric depression scale for screening of depression among older adults: systematic review and meta-analysis. Arch Gerontol Geriatr, 87:104002.
  • Kubota Y, Chen LY, Whitsel EA, Folsom AR (2017) Heart rate variability and lifetime risk of cardiovascular disease: the atherosclerosis risk in communities study. Ann Epidemiol, 27:619-625.
  • Kumar C, Sakshi P, Sinha N, Sunita, Kumar T (2024) HRV changes in young adults with depression. J Family Med Prim Care, 13:2585-2588.
  • Liu J, Xie H, Liu M, Wang Z, Zou L, Yeung AS, Hui SS, Yang Q (2018) The effects of Tai Chi on heart rate variability in older Chinese individuals with depression. Int J Environ Res Public Health, 15:2771.
  • McCraty R, Shaffer F (2015) Heart rate variability: new perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Glob Adv Health Med, 4:46-61.
  • McNames J, Aboy M (2006) Reliability and accuracy of heart rate variability metrics versus ECG segment duration. Med Biol Eng Comput, 44:747-756.
  • Orgeta V, Brede J, Livingston G (2017) Behavioural activation for depression in older people: systematic review and meta-analysis. Br J Psychiatry, 211:274-279.
  • Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372:n71.
  • Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC et al. (2016) Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet, 388:871-880.
  • Sammito S, Böckelmann I (2016) Reference values for time-and frequency-domain heart rate variability measures. Heart Rhythm, 13:1309-1316.
  • Sayar K, Güleç H, Gökçe M, Ak I (2002) Heart rate variability in depressed patients. Klinik Psikofarmakol Bult, 12:130-133.
  • Sgoifo A, Carnevali L, Pico Alfonso M de los A, Amore M (2015) Autonomic dysfunction and heart rate variability in depression. Stress, 18:343-352.
  • Sözeri-Varma G (2012) Depression in the elderly: clinical features and risk factors. Aging Dis, 3:465-471.
  • Stein PK, Reddy A (2005) Non-linear heart rate variability and risk stratification in cardiovascular disease. Indian Pacing Electrophysiol J, 5:210-220.
  • Thomas AJ, O’Brien JT (2009) Mood disorders in the elderly. Psychiatry, 8:56-60.
  • Tiwari R, Kumar R, Malik S, Raj T, Kumar P (2021) Analysis of heart rate variability and implication of different factors on heart rate variability. Curr Cardiol Rev, 17:e160721189770.
  • Tobaldini E, Carandina A, Toschi-Dias E, Erba L, Furlan L, Sgoifo A et al. (2020) Depression and cardiovascular autonomic control: a matter of vagus and sex paradox. Neurosci Biobehav Rev, 116:154-161.
  • Turcu AM, Ilie AC, Ștefăniu R, Țăranu SM, Sandu IA, Alexa-Stratulat T et al. (2023) The impact of heart rate variability monitoring on preventing severe cardiovascular events. Diagnostics, 13:2382.
  • Wang HM, Huang SC (2012) SDNN/RMSSD as a surrogate for LF/HF: a revised investigation. Model Simul Eng, 2012:931943.
  • WHO (2024). Depression fact sheet. https://www.who.int/news-room/fact-sheets/detail/depression (Accessed 09/09/2024).
  • Wu Q, Miao X, Cao Y, Chi A, Xiao T (2023) Heart rate variability status at rest in adult depressed patients: a systematic review and meta-analysis. Front Public Health, 11:1243213.
  • Zou L, Sasaki JE, Wei GX, Huang T, Yeung AS, Neto OB et al. (2018) Effects of mind-body exercises (Tai Chi/Yoga) on heart rate variability parameters and perceived stress: a systematic review with meta-analysis of randomized controlled trials. J Clin Med, 7:404.

Depresyonu Olan Yaşlı Hastalarda Kalp Hızı Değişkenliğinde Oluşan Değişiklikler: Sistematik Bir Derleme

Year 2025, Volume: 17 Issue: 4, 716 - 725

Leyla Aydın , Sena Kabakçı

https://doi.org/10.18863/pgy.1556204

Abstract

Depresyon, kişinin ruh halini ve günlük aktivitelerini etkileyen ve ciddi semptomlara neden olabilen yaygın bir duygudurum bozukluğudur. Depresyon yalnızca ruh halini etkilemekle kalmayıp aynı zamanda kişinin otonom sinir sisteminde işlev bozukluklarına da neden olabilir. Özellikle yaşlı bireylerde depresyon sıklıkla komplikedir ve yönetimi zorlaştırmaktadır. Depresyon tanısı alan bireylerde otonom sinir sisteminin değerlendirilmesi hastalığın seyri açısından büyük önem taşımaktadır. Otonom sinir sisteminin kantitatif değerlendirmesi için kullanılan invaziv olmayan yöntemlerden biri de kalp hızı değişkenliğinin (HRV) bilgisayarlı analizidir. Depresyon tanısı alan bireylerde HRV değişikliklerini inceleyen çalışmalarda farklı sonuçlar elde edilmiştir. Ayrıca yaşın HRV üzerinde etkili bir role sahip olduğu bilinmesine rağmen geriatrik yaş grubunda yeterli çalışmaya rastlanmamıştır. Bu sistematik derlemede depresyon tanısı almış ileri yaştaki bireylerdeki HRV değişimlerini incelemek amaçlanmıştır. Bu derlemeye; 2017 yılından10/09/2024 tarihine kadar Wiley, Web of Science, Springer Link, Scopus, Science Direct, PubMed, APA PsycArticles ve The Networked Digital Library of Theses and Dissertations (NDLTD) veritabanlarında taranan 688 çalışmadan, arama kriterlerini karşılayan 3 randomize kontrollü çalışma dâhil edildi. Sistematik incelememiz sonucunda yaşlı depresyon hastalarına uygulanan farklı meditasyon ve egzersiz programlarının otonom sinir sistemi ve HRV parametreleri üzerinde farklı etkileri olabileceği sonucuna ulaştık. Ancak derlememizin temel çıkış noktası olan yaşlı depresyon hastaları ile sağlıklı kontroller arasında HRV parametrelerindeki farklılıkları inceleyen bir çalışmaya rastlamadık. Çalışmamızdaki bu primer sınırlılık, aynı zamanda mevcut literatürdeki eksikliğin ciddiyetini açığa çıkarmaktadır. İleri yaşlarda depresyon oranının yüksek olduğu göz önüne alındığında bu konuda daha fazla çalışmaya ihtiyaç vardır.

Keywords

Kalp Atış Hızı Değişkenliği Depresyon Yaşlı popülasyon

References

  • Agorastos A, Mansueto AC, Hager T, Pappi E, Gardikioti A, Stiedl O (2023) Heart rate variability as a translational dynamic biomarker of altered autonomic function in health and psychiatric disease. Biomedicines, 11:1591.
  • Arantes FS, Rosa Oliveira V, Leão AKM, Afonso JPR, Fonseca AL, Fonseca DRP (2022) Heart rate variability: a biomarker of frailty in older adults? Front Med, 9:1008970.
  • Ayudhaya WSN, Pityaratstian N, Eungpinichpong W, Rattananupong T, Kitidumrongsuk P, Loonlawong S (2022) Effect of behavioral activation on time and frequency domain heart rate variability in older adults with subthreshold depression: a cluster randomized controlled trial in Thailand. BMC Psychiatry, 22:319.
  • Blase KL, van Waning A (2019) Heart rate variability, cortisol, and attention focus during Shamatha quiescence meditation. Appl Psychophysiol Biofeedback, 44:331-342
  • Boztaş MH, Arısoy Ö (2010) Tıbbi hastalıklarda depresyon: tanısal sorunlar. Psikiyatride Güncel Yaklaşımlar, 2:318-332.
  • Brown L, Karmakar C, Gray R, Jindal R, Lim T, Bryant C (2018) Heart rate variability alterations in late life depression: a meta-analysis. J Affect Disord, 1:456-466.
  • Carney RM, Freedland KE (2017) Depression and coronary heart disease. Nat Rev Cardiol, 14:145-155.
  • Chuang HW, Kao CW, Lee MD, Chang YC (2018) Effectiveness of the story-centred care intervention program in older persons living in long-term care facilities: a randomized, longitudinal study. PLoS One, 13:e0194178.
  • Cygankiewicz I, Zareba W (2013) Heart rate variability. Handb Clin Neurol, 117:379-393.
  • Ekers D, Richards D, McMillan D, Bland JM, Gilbody S (2011) Behavioural activation delivered by the non-specialist: phase II randomized controlled trial. Br J Psychiatry, 198:66-72.
  • European Society of Cardiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation, 93:1043-1065.
  • Evans M, Mottram P (2000) Diagnosis of depression in elderly patients. Adv Psychiatr Treat, 6:49-56.
  • Gevirtz RN, Lehrer PM, Schwartz MS (2016) Cardiorespiratory biofeedback. In Biofeedback: A Practitioner’s Guide (Eds MS Schwartz, F Andrasik). New York, Guilford Press.
  • Gilsanz P, Karter AJ, Beeri MS, Quesenberry CP Jr, Whitmer RA (2018) The bidirectional association between depression and severe hypoglycemic and hyperglycemic events in type 1 diabetes. Diabetes Care, 41:446-452.
  • Göçen HB, Özden AV (2024) Autonomic dysfunction in psychiatric disorders. Psikiyatride Güncel Yaklaşımlar, 16:401-409.
  • Goldberger AL (1991) Is the normal heartbeat chaotic or homeostatic? News Physiol Sci, 6:87-91.
  • Grippo AJ, Johnson AK (2002) Biological mechanisms in the relationship between depression and heart disease. Neurosci Biobehav Rev, 26:941-962.
  • Jangpangi D, Mondal S, Bandhu R, Kataria D, Gandhi A (2016) Alteration of heart rate variability in patients with depression. J Clin Diagn Res, 10:CM04-CM06.
  • JBI (2017) The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews:Checklist for Randomized Controlled Trials. https://jbi.global/sites/default/files/2019-05/JBI_RCTs_Appraisal_tool2017_0.pdf (accessed 09/09/2024).
  • Kemp AH, Quintana DS, Gray MA, Felmingham KL, Brown K, Gatt JM (2010) Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry, 67:1067-1074.
  • Kidwell M, Ellenbroek BA (2018) Heart and soul: heart rate variability and major depression. Behav Pharmacol, 29:152-164.
  • Kim W, Lim SK, Chung EJ, Woo JM (2009) The effect of cognitive behavior therapy-based psychotherapy applied in a forest environment on physiological changes and remission of major depressive disorder. Psychiatry Investig, 6:245-254.
  • Koch C, Wilhelm M, Salzmann S, Rief W, Euteneuer F (2019) A meta-analysis of heart rate variability in major depression. Psychol Med, 49:1948-1957.
  • Krishnamoorthy Y, Rajaa S, Rehman T (2020) Diagnostic accuracy of various forms of geriatric depression scale for screening of depression among older adults: systematic review and meta-analysis. Arch Gerontol Geriatr, 87:104002.
  • Kubota Y, Chen LY, Whitsel EA, Folsom AR (2017) Heart rate variability and lifetime risk of cardiovascular disease: the atherosclerosis risk in communities study. Ann Epidemiol, 27:619-625.
  • Kumar C, Sakshi P, Sinha N, Sunita, Kumar T (2024) HRV changes in young adults with depression. J Family Med Prim Care, 13:2585-2588.
  • Liu J, Xie H, Liu M, Wang Z, Zou L, Yeung AS, Hui SS, Yang Q (2018) The effects of Tai Chi on heart rate variability in older Chinese individuals with depression. Int J Environ Res Public Health, 15:2771.
  • McCraty R, Shaffer F (2015) Heart rate variability: new perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Glob Adv Health Med, 4:46-61.
  • McNames J, Aboy M (2006) Reliability and accuracy of heart rate variability metrics versus ECG segment duration. Med Biol Eng Comput, 44:747-756.
  • Orgeta V, Brede J, Livingston G (2017) Behavioural activation for depression in older people: systematic review and meta-analysis. Br J Psychiatry, 211:274-279.
  • Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372:n71.
  • Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC et al. (2016) Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet, 388:871-880.
  • Sammito S, Böckelmann I (2016) Reference values for time-and frequency-domain heart rate variability measures. Heart Rhythm, 13:1309-1316.
  • Sayar K, Güleç H, Gökçe M, Ak I (2002) Heart rate variability in depressed patients. Klinik Psikofarmakol Bult, 12:130-133.
  • Sgoifo A, Carnevali L, Pico Alfonso M de los A, Amore M (2015) Autonomic dysfunction and heart rate variability in depression. Stress, 18:343-352.
  • Sözeri-Varma G (2012) Depression in the elderly: clinical features and risk factors. Aging Dis, 3:465-471.
  • Stein PK, Reddy A (2005) Non-linear heart rate variability and risk stratification in cardiovascular disease. Indian Pacing Electrophysiol J, 5:210-220.
  • Thomas AJ, O’Brien JT (2009) Mood disorders in the elderly. Psychiatry, 8:56-60.
  • Tiwari R, Kumar R, Malik S, Raj T, Kumar P (2021) Analysis of heart rate variability and implication of different factors on heart rate variability. Curr Cardiol Rev, 17:e160721189770.
  • Tobaldini E, Carandina A, Toschi-Dias E, Erba L, Furlan L, Sgoifo A et al. (2020) Depression and cardiovascular autonomic control: a matter of vagus and sex paradox. Neurosci Biobehav Rev, 116:154-161.
  • Turcu AM, Ilie AC, Ștefăniu R, Țăranu SM, Sandu IA, Alexa-Stratulat T et al. (2023) The impact of heart rate variability monitoring on preventing severe cardiovascular events. Diagnostics, 13:2382.
  • Wang HM, Huang SC (2012) SDNN/RMSSD as a surrogate for LF/HF: a revised investigation. Model Simul Eng, 2012:931943.
  • WHO (2024). Depression fact sheet. https://www.who.int/news-room/fact-sheets/detail/depression (Accessed 09/09/2024).
  • Wu Q, Miao X, Cao Y, Chi A, Xiao T (2023) Heart rate variability status at rest in adult depressed patients: a systematic review and meta-analysis. Front Public Health, 11:1243213.
  • Zou L, Sasaki JE, Wei GX, Huang T, Yeung AS, Neto OB et al. (2018) Effects of mind-body exercises (Tai Chi/Yoga) on heart rate variability parameters and perceived stress: a systematic review with meta-analysis of randomized controlled trials. J Clin Med, 7:404.
There are 45 citations in total.

Details

Primary Language English
Subjects Psychophysiology
Journal Section Review
Authors

Leyla Aydın 0000-0001-8771-5030

Sena Kabakçı 0009-0005-6832-2406

Publication Date
Submission Date September 25, 2024
Acceptance Date February 26, 2025
Published in Issue Year 2025 Volume: 17 Issue: 4

Cite

AMA Aydın L, Kabakçı S. Heart Rate Variability Changes in Elderly Patients with Depression: A Systematic Review. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. 17(4):716-725. doi:10.18863/pgy.1556204

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Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.