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Depression and cardiac dysautonomia in eating disorders

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Individuals with eating disorder (ED) are at an increased risk of cardiac arrhythmias due to cardiac dysautonomia, which may be exacerbated if depression is also present. The aim of the study was to use heart rate analysis as a marker for cardiac dysautonomia in patients with eating disorders and depression as a comorbidity.

Methods

Clinical data, including presence of depression, was obtained from all participants. A three-lead ECG was used to determine interbeat intervals, and these were analyzed using time domain, frequency domain, and nonlinear heart rate variability measures.

Results

Thirty ED patients and 44 healthy controls participated in the research. The presence of depression was associated with additional decreased time domain (RMSSD 36.8 ± 26 vs. 22.9 ± 12.3; p < 0.05), frequency domain (HF power 788 ± 1075 vs. 279 ± 261; p < 0.05), and nonlinear domain (DFAα2 0.82 ± 0.1 vs. 0.97 ± 0.1; p < 0.01) which results in the ED group compared to patients with no depression.

Conclusions

The presence of depression in ED patients decreased HRV even further compared to the non-depressed patient group and controls, suggesting that higher vigilance and a holistic treatment approach may be required for these patients to avoid cardiac arrhythmia complications.

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References

  1. American Psychiatric Association (2000) Practice guideline for the treatment of patients with eating disorders (revision). Am J Psych 157(1):1–39

    Article  Google Scholar 

  2. Jauregui-Garrido B, Jauregui-Lobera I (2012) Sudden death in eating disorders. Vasc Health Risk Manag 8:91–98. doi:10.2147/vhrm.s28652

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yager J, Andersen AE (2005) Anorexia nervosa. New Engl J Med 353(14):1481–1488. doi:10.1056/NEJMcp050187

    Article  PubMed  CAS  Google Scholar 

  4. Lonsdale D (2009) Dysautonomia, a heuristic approach to a revised model for etiology of disease. Evid Based Complement Altern Med 6(1):3–10. doi:10.1093/ecam/nem064

    Article  Google Scholar 

  5. Huikuri HV, Perkiömäki JS, Maestri R, Pinna GD (2009) Clinical impact of evaluation of cardiovascular control by novel methods of heart rate dynamics. Phil Trans R Soc A 367(1892):1223–1238. doi:10.1098/rsta.2008.0294

    Article  PubMed  Google Scholar 

  6. Takimoto Y, Yoshiuchi K, Ishizawa T, Yamamoto Y, Akabayashi A (2014) Autonomic dysfunction responses to head-up tilt in anorexia nervosa. Clin Autonomic Res 24(4):175–181. doi:10.1007/s10286-014-0250-1

    Article  Google Scholar 

  7. Mazurak N, Stein J, Kipphan S, Muth ER, Teufel M, Zipfel S, Enck P (2011) Heart rate variability in anorexia nervosa and the irritable bowel syndrome. Neurogastroenterol Motil 23(11):e470–e478. doi:10.1111/j.1365-2982.2011.01785.x

    Article  PubMed  CAS  Google Scholar 

  8. Kemp AH, Quintana DS, Felmingham KL, Matthews S, Jelinek HF (2012) Heart rate variability in unmedicated depressed patients without comorbid cardiovascular disease. PloS One 7(2):e30777. doi:10.1371/journal.pone.0030777

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Becker AE, Grinspoon SK, Klibanski A, Herzog DB (1999) Eating disorders. New Engl J Med 340(14):1092–1098. doi:10.1056/NEJM199904083401407

    Article  PubMed  CAS  Google Scholar 

  10. La Rovere M, Bigger J, Marcus F, Mortara A, Schwartz P (1998) Baroreflex sensitivity and heart rate variability in prediction of total cardiac mortality after myocardial infarction. Lancet 351(9101):478–484

    Article  PubMed  CAS  Google Scholar 

  11. Brunckhorst CB, Holzmeister J, Scharf C, Binggeli C, Duru F (2003) Stress, depression and cardiac arrhythmias. Therapeutische Umschau Revue therapeutique 60(11):673–681. doi:10.1024/0040-5930.60.11.673

    Article  PubMed  CAS  Google Scholar 

  12. Agelink MW, Boz C, Ullrich H, Andrich J (2002) Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Res 113(1–2):139–149

    Article  PubMed  Google Scholar 

  13. Carney RM, Freedland KE, Steinmeyer B, Rubin EH, Mann DL, Rich MW (2016) Cardiac risk markers and response to depression treatment in patients with coronary heart disease. Psychosom Med 78(1):49–59. doi:10.1097/psy.0000000000000245

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Jelinek HF, Khandoker A, Quintana D, Issam HM, Kemp AH (2011) Complex Correlation Measure as a sensitive indicator of risk for sudden cardiac death in patients with depression. Paper presented at the Computing in Cardiology, Hangzhou, China

  15. Task Force (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(5):1043–1065

    Article  Google Scholar 

  16. Singer DH, Martin GJ, Magid N, Weiss JS, Schaad JW, Kehoe R, Zheutlin T, Fintel DJ, Hsieh AM, Lesch M (1988) Low heart rate variability and sudden cardiac death. J Electrocardiol 21(Suppl):S46–S55

    Article  PubMed  Google Scholar 

  17. Mäkikallio TH, Tapanainen JM, Tulppo MP, Huikuri HV (2002) Clinical applicability of heart rate variability analysis by methods based on nonlinear dynamics. Cardiac Electrophysiol Rev 6:250–255

    Article  Google Scholar 

  18. Ishizawa T, Yoshiuchi K, Takimoto Y, Yamamoto Y, Akabayashi A (2008) Heart rate and blood pressure variability and baroreflex sensitivity in patients with anorexia nervosa. Psychosom Med 70(6):695

    Article  PubMed  Google Scholar 

  19. Wu Y, Nozaki T, Inamitsu T, Kubo C (2004) Physical and psychological factors influencing heart rate variability in anorexia nervosa. Eat Weight Disord 9:296–299

    Article  PubMed  CAS  Google Scholar 

  20. Garner DM, Garkinkel PE (1979) The eating attitudes test: an index of the symptons of anorexia nervosa. Psychol Med 9:273–279

    Article  PubMed  CAS  Google Scholar 

  21. Beck AT, Steer RA, Brwon GK (2001) Beck depression inventory II. In: Plake BS, Impara JC (eds) The fourteenth mental measurements yearbook. Psychological Corporation, San Antonia

    Google Scholar 

  22. Pincus SM (1991) Approximate entropy as a measure of system complexity. Proc Natl Acad Sci USA 88:2297–2301

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Peng CK, Havlin S, Eugene Stanley H, Goldberger AL (1995) Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series. Chaos 5(1):82–87

    Article  PubMed  CAS  Google Scholar 

  24. Ihlen EAFr (2012) Introduction to multifractal wavelet and detrended fluctuation analyses. Front Physiol 3. doi:10.3389/fphys.2012.00141

  25. Peterson RE, Latendresse SJ, Bartholome LT, Warren CS, Raymond NC (2012) Binge eating disorder mediates links between symptoms of depression, anxiety, and caloric intake in overweight and obese women. J Obesity 2012:8. doi:10.1155/2012/407103

    Article  Google Scholar 

  26. Agelink MW, Boz C, Ullrich H, Andrich J (2002) Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Res 113:139–149

    Article  PubMed  Google Scholar 

  27. Vigo DE, Siri LN, de D Guevara MS, Martinez-Martinez JA, Fahrer RD, Cardinali DP, Masoli O, Guinjoan SM (2004) Relation of depression to heart rate nonlinear dynamics in patients greater than 60 years of age with recent unstable angina pectoris or acute myocardial infarction. Am J Cardiol 93:756–760

    Article  PubMed  Google Scholar 

  28. Gehi A, Mangano D, Pipkin S, Browner WS, Whooley MA (2005) Depression and heart rate variability in patients with stable coronary heart disease. Arch Gen Psychiatry 62:661–666

    Article  PubMed  PubMed Central  Google Scholar 

  29. Murialdo G, Casu M, Falchero M, Brugnolo A, Patrone V, Cerro PF, Ameri P, Andraghetti G, Briatore L, Copello F, Cordera R, Rodriguez G, Ferro AM (2007) Alterations in the autonomic control of heart rate variability in patients with anorexia or bulimia nervosa: correlations between sympathovagal activity, clinical features, and leptin levels. J Endocrinol Invest 30(5):356–362

    Article  PubMed  CAS  Google Scholar 

  30. Casu M, Patrone V, Gianelli MV, Marchegiani A, Ragni G, Murialdo G, Polleri A (2002) Spectral analysis of R-R interval variability by short-term recording in anorexia nervosa. Eat Weight Disord 7(3):239–243

    Article  PubMed  CAS  Google Scholar 

  31. Kollai M, Bonyhay I, Jokkel G, Szonyi L (1994) Cardiac vagal hyperactivity in adolescent anorexia nervosa. Eur Heart J 15(8):1113–1118

    Article  PubMed  CAS  Google Scholar 

  32. Russell J, Hijazi S, Edington L, Spence I, Jelinek HF (2009) Cardiovascular complications and sudden death associated with eating disorders. Int J Cardiovasc Res 7(1):1–5

  33. Crifaci G, Billeci L, Tartarisco G, Balocchi R, Pioggia G, Brunori E, Maestro S, Morales MA (2013) ECG and GSR measure and analysis using wearable systems: application in anorexia nervosa adolescents. In: Image and signal processing and analysis (ISPA), 2013 8th international symposium on, 4–6 Sept 2013, pp 499–504. doi:10.1109/ISPA.2013.6703792

  34. Yeragani VK, Pesce V, Jayaraman A, Roose S (2002) Major depression with ischemic heartdisease: effects of paroxetine and nortriptyline on long-term heart rate variability measures. Biol Psychiatry 52:418–429

    Article  PubMed  CAS  Google Scholar 

  35. Siepmann M, Handel J, Mueck-Weymann M, Kirch W (2004) The effects of Moclobemide on autonomic and cognitive functions in healthy volunteers. Pharmacopsychiatry 37:81–87

    Article  PubMed  CAS  Google Scholar 

  36. Silke B, Campbell C, King DJ (2002) The potential cardiotoxicity of anitpsychotic drugs as assessed by heart rate variability. J Psychopharmacol 16(4):355–360

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We wish to acknowledge the support by staff and patients at the Northside Clinic. Susan Beale provided the data, which was collected as part of her honours project.

Funding

No sponsorship or grants were received for this research.

Author information

Authors and Affiliations

  1. Australian School of Advanced Medicine, Macquarie University, Sydney, Australia

    Herbert F. Jelinek

  2. School of Community Health and Centre for Research in Complex Systems, Charles Sturt University, Albury, NSW2460, Australia

    Herbert F. Jelinek

  3. Discipline of Pharmacology, Sydney Medical School, Sydney University, Sydney, Australia

    Ian Spence

  4. School of Design, Computing and Information Technology, University of Newcastle andApplied Informatics Research Group, University of Newcastle, Callaghan, Australia

    David J. Cornforth

  5. Department of Applied Physics, University of Eastern, Kuopio, Finland

    Mika P. Tarvainen

  6. Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland

    Mika P. Tarvainen

  7. Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia

    Janice Russell

  8. Northside Clinic Eating Disorders Program, Sydney University, Greenwich, Sydney, Australia

    Janice Russell

Authors
  1. Herbert F. Jelinek
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  2. Ian Spence
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  3. David J. Cornforth
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  4. Mika P. Tarvainen
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  5. Janice Russell
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Corresponding author

Correspondence to Herbert F. Jelinek.

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Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Work was carried out at the Northside Clinic and Sydney University.

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Jelinek, H.F., Spence, I., Cornforth, D.J. et al. Depression and cardiac dysautonomia in eating disorders. Eat Weight Disord 23, 369–374 (2018). https://doi.org/10.1007/s40519-017-0363-3

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  • DOI: https://doi.org/10.1007/s40519-017-0363-3

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