Vagally-mediated heart rate variability and depression in children and adolescents - A meta-analytic update

Heart rate variability in mental disorders: an umbrella review of meta-analyses

Heart rate variability (HRV) monitoring is increasingly applied in the realm of mental disorders; however, it remains a subject of controversy. This umbrella review summarizes HRV differences between individuals with mental disorders and healthy controls (HCs), as well as changes in HRV before and after treatment in patients with mental disorders. A literature search was conducted using Medline, PubMed, Embase, and the Cochrane Database. Meta-analyses on HRV changes in patients with mental disorders, as well as meta-analyses comparing HCs and patients with mental disorders were included. We computed the summary effect size using random effects models, along with 95% confidence and prediction intervals. We assessed heterogeneity, p value of the largest study, excess significance bias, and small-study effects. Evidence levels were classified as convincing, highly suggestive, suggestive, weak, or not significant. Twenty-one systematic reviews on HRV, covering 19 mental disorders (53 meta-analyses) and 8 treatment modalities (18 meta-analyses), included 442 primary studies and 34,625. For differences between mental disorders and HCs, evidence was suggestive for 7 (13.2%) pooled analyses, indicating decreased HRV in dementia, PTSD, somatic symptom disorders, functional somatic syndromes, and schizophrenia. For other disorders, including autism spectrum disorder, alcohol use disorder, bipolar disorder, generalized anxiety disorder, insomnia, and major depressive disorder, the evidence was weaker and below the suggestive level. For treatment effects, 5 pooled analyses (27.8%) had weak evidence, indicating altered HRV before and after antipsychotic treatment, repetitive transcranial magnetic stimulation treatment, physiotherapy, and psychotherapy. The credibility of HRV evidence in mental disorders varied across HRV variables and diseases. No two diseases exhibited identical altered HRV patterns, highlighting the potential significance of overall HRV profiles in delineating distinct disorders.

Effects of Adding Facial Immersion to Chest-Level Water Immersion on Vagally-Mediated Heart Rate Variability

Recent studies have shown that both facial immersion and head-out water immersion up to the chest (HOIC) positively influence cardiac vagal activity, as indexed non-invasively through vagally mediated heart rate variability (vmHRV). While facial immersion activates the diving reflex, HOIC induces effects via hydrostatic pressure, each engaging distinct physiological mechanisms. This study aims to investigate whether combining facial immersion with HOIC results in an additional increase in vmHRV. In total, the vmHRV [log10RMSSD] of 37 participants (14 females, Mage = 23.8; SDage = 4.4 years) was assessed under two conditions, with resting and recovery measurements taken before and after each condition. The first condition involved HOIC alone (M = 1.97, SD = 0.27), followed by HOIC combined with facial immersion (M = 1.87, SD = 0.29). HOIC alone significantly increased RMSSD compared to baseline (p < 0.001); however, no additional increase was observed when facial immersion was added (p = 0.436). This suggests that, while HOIC effectively increases vmHRV, the addition of facial immersion does not provide any further enhancement under the conditions tested. Potential methodological limitations, such as the absence of breath holding, variability in immersion depth, and the use of thermoneutral water temperatures, may have influenced the outcomes and warrant further investigation.

The relationship between depression severity and heart rate variability in children and adolescents: A meta-analysis

OBJECTIVE

Depression in children and adolescents has gradually attracted social attention. Heart rate variability (HRV) has been found to be influenced by depression severity, but results have not been uniformed in children and adolescents. This study investigated the relationship between depression severity and heart rate variability in children and adolescents, aiming to provide additional evidence for an objective, effective, and convenient depression screening tool in this population.

METHODS

Literature searching was conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, PubMed, ScienceDirect, and EBSCO. Relevant studies investigating the relationship between depression severity and HRV in children and adolescents were selected for meta-analysis.

RESULTS

31 articles were included in this meta-analysis, involving 4534 participants. Depression severity in children and adolescents was significantly negatively correlated with high frequency (HF) and root mean square of successive differences (RMSSD) in HRV (HF: r = -0.10, 95% CI: -0.17 to -0.04, p = 0.001; RMSSD: r = -0.18, 95% CI: -0.30 to -0.05, p = 0.01). The relationship between HF and depression severity was moderated by age, higher among those aged >12 than among those aged <12 (r = -0.17, -0.02, Q = 7.32, p = 0.007).

CONCLUSION

Heart rate variability is associated with depression severity in children and adolescents.

Vortioxetine's impact on the autonomic nervous system in depressed children and adolescents: analysis of the heart rate variability

Relationship between depressive disorder and autonomic nervous system has been already discussed. Reduced emotional regulation is supposed to be associated with prefrontal hypofunction and subcortical hyperactivity. The aim of this study was to determine the effect of vortioxetine on heart rate variability (HRV), a parameter of cardiac autonomic regulation, in depressed hospitalized paediatric patients and assess the clinical effectiveness of the drug in this population. We performed repeated polysomnography analyses at admission and after a short treatment in hospital (15.2 days on average) and measured various HRV parameters (RRi, pNN50, RMSSD, LF-HRV, HF-HRV) during wakefulness, N3 and REM sleep stages. Out of 27 study subjects, 67% have improved depression symptoms as well as anxiety and subjective sleep quality after short vortioxetine treatment. We have found a significant decrease in parasympathetic parameters pNN50, RMSSD and HF-HRV during N3 sleep phase, though not exclusively among vortioxetine responders. The anticipated increase in cardiovagal regulation after vortioxetine treatment was not demonstrated in this pilot study, possibly due to the drug's multimodal mechanism and impact on the nucleus tractus solitarii, particularly its antagonism on 5HT-3 receptors. Application of selective drugs could further explain the effect of vortioxetine on HRV in depressed patients.

A sex-specific pathway linking early life maltreatment, vagal activity, and depressive symptoms

Background: Experiences of early life maltreatment (ELM) are alarmingly common and represent a risk factor for the development of psychopathology, particularly depression. Research has focused on alterations in autonomic nervous system (ANS) functioning as a mediator of negative mental health outcomes associated with ELM. Early alterations in autonomic vagal activity (vmHRV) may moderate the relationship between ELM and depression, particularly when considering forms of emotional maltreatment. Recent evidence suggests that the relationships of both ELM and vmHRV with depression may be non-linear, particularly considering females.Objective: Building on and extending theoretical considerations and previous work, the present work aims to further the current understanding of the complex relationships between ELM exposure, vmHRV, and depression.Methods: This study uses an adaptive modelling approach, combining exploratory network-based analyses with linear and quadratic moderation analyses, drawing on a large sample of males and females across adolescence (total N = 213; outpatient at-risk sample and healthy controls) and adulthood (total N = 85; community-based convenience sample).Results: Exploratory network-based analyses reveal that exposure to emotional abuse is particularly central within a network of ELM subtypes, depressive symptoms, and concurrent vmHRV in both adolescents and adults. In adults, emotional neglect shows strong associations with both emotional abuse and vmHRV and is highly central as a network node, which is not observed in adolescents. Moderator analyses reveal significant interactions between emotional maltreatment and vmHRV predicting depressive symptoms in adult females. Significant quadratic relationships of emotional maltreatment and vmHRV with depression are observed in both adolescent and adult females.Conclusions: The present findings contribute to the understanding of the psychological and physiological mechanisms by which ELM acts as a risk factor for the development of depression. Ultimately, this will contribute to the development of targeted and effective intervention strategies to mitigate the detrimental effects of early adversity.

Anthracycline's Effects on Heart Rate Variability in Children with Acute Lymphoblastic Leukemia: Early Toxicity Signs-Pilot Study

Anthracycline treatments are known to cause cardiotoxic long-term side effects in cancer survivors. Recently, a decrease in heart rate variability (HRV) has been identified in these patients, signaling autonomic dysfunction and altered cardiac fitness. This study aimed at evaluating changes in HRV in children treated with anthracyclines. A total of 35 pediatric patients with acute lymphoblastic leukemia were evaluated by means of a 24 h Holter ECG, at baseline and after reaching half the total cumulative dose of doxorubicin equivalent (120 mg/m2). Parameters of HRV were assessed, as well as any arrhythmic episodes, bradycardia and tachycardia percentages. The results showed a significant decrease in both time-domain and frequency-domain HRV parameters, following anthracycline treatment. The low-frequency (LF) to high-frequency (HF) parameters' ratio also displayed a significant difference (p = 0.035), suggestive of early cardiac autonomic dysfunction. Of note, none of the patients presented symptoms of heart disease or elevated troponins, and only two patients presented echocardiographic signs of diastolic dysfunction. The present study showed that cardiac autonomic nervous system regulation is compromised in children treated with anthracyclines even before reaching the total cumulative dose. Therefore, HRV parameters could be the first indicators of subclinical cardiac toxicity, making Holter ECG monitoring of the oncological patient a necessity.