Annals of Behavioral Medicine

, Volume 46, Issue 1, pp 73–80 | Cite as

Association Between Smoking and Heart Rate Variability Among Individuals with Depression

  • Christopher B. Harte
  • Gabrielle I. Liverant
  • Denise M. Sloan
  • Barbara W. Kamholz
  • Laina E. Rosebrock
  • Maurizio Fava
  • Gary B. Kaplan
Original Article



Both depression and smoking have been independently associated with lower heart rate variability (HRV), suggesting dysregulation of cardiac autonomic function. However, no studies have systematically explored the effects of smoking on HRV among depressed patients.


This study examined differences in HRV based on smoking status among depressed individuals.


Electrophysiological data were examined among 77 adult outpatients without a history of myocardial infarction, who met criteria for major depressive disorder or dysthymia. Frequency domain [low frequency (LF), high frequency (HF), LF/HF ratio, respiratory sinus arrhythmia (RSA)] parameters of HRV, and heart rate and inter-beat interval (IBI) data were compared between depressed smokers (n = 34) and depressed nonsmokers (n = 44).


After controlling for covariates, depressed smokers, compared to depressed nonsmokers, displayed significantly lower LF, HF, and RSA.


Among depressed patients, smoking is associated with significantly lower HRV, indicating dysregulated autonomic modulation of the heart.


Smoking Depression Heart rate variability Cardiac autonomic regulation Autonomic nervous system 


Author Note

Christopher B. Harte, Research Service, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine; Gabrielle I. Liverant, Mental Health Service, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine; Denise M. Sloan, National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine; Barbara W. Kamholz, Mental Health Service, VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, and Department of Psychology, Boston University; Laina Rosebrock, Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System; Maurizio Fava, Department of Psychiatry, Massachusetts General Hospital and Department of Psychiatry, Harvard Medical School; Gary B. Kaplan, Mental Health Service, VA Boston Healthcare System and Department of Psychiatry, Pharmacology, and Psychology, Boston University School of Medicine.

This investigation was supported by a VA Career Development Award, Department of Veterans Affairs, awarded to the second author, Dr. Gabrielle Liverant. The authors would like to acknowledge Kimberly Arditte and Daniel Lee for their assistance with recruitment and data collection for this study.

Conflict of Interest Statement

Maurizio Fava has the following lifetime disclosures:

Research Support: Abbot Laboratories; Alkermes, Inc.; Aspect Medical Systems; AstraZeneca; BioResearch; BrainCells Inc.; Bristol-Myers Squibb; CeNeRx BioPharma; Cephalon; Clinical Trials Solutions, LLC; Clintara, LLC; Covance; Covidien; Eli Lilly and Company; EnVivo Pharmaceuticals, Inc.; Euthymics Bioscience, Inc.; Forest Pharmaceuticals, Inc.; Ganeden Biotech, Inc.; GlaxoSmithKline; Icon Clinical Research; i3 Innovus/Ingenix; Johnson & Johnson Pharmaceutical Research & Development; Lichtwer Pharma GmbH; Lorex Pharmaceuticals; National Alliance for Research on Schizophrenia & Depression (NARSAD); National Center for Complementary and Alternative Medicine (NCCAM); National Institute of Drug Abuse (NIDA); National Institute of Mental Health (NIMH); Novartis AG; Organon Pharmaceuticals; PamLab, LLC.; Pfizer Inc.; Pharmavite® LLC; Photothera; Roche Pharmaceuticals; RCT Logic, LLC; Sanofi-Aventis US LLC; Shire; Solvay Pharmaceuticals, Inc.; Synthelabo; Wyeth-Ayerst Laboratories

Advisory/Consulting: Abbott Laboratories; Affectis Pharmaceuticals AG; Alkermes, Inc.; Amarin Pharma Inc.; Aspect Medical Systems; AstraZeneca; Auspex Pharmaceuticals; Bayer AG; Best Practice Project Management, Inc.; BioMarin Pharmaceuticals, Inc.; Biovail Corporation; BrainCells Inc; Bristol-Myers Squibb; CeNeRx BioPharma; Cephalon, Inc.; Clinical Trials Solutions, LLC; CNS Response, Inc.; Compellis Pharmaceuticals; Cypress Pharmaceutical, Inc.; DiagnoSearch Life Sciences (P) Ltd.; Dinippon Sumitomo Pharma Co. Inc.; Dov Pharmaceuticals, Inc.; Edgemont Pharmaceuticals, Inc.; Eisai Inc.; Eli Lilly and Company; EnVivo Pharmaceuticals, Inc.; ePharmaSolutions; EPIX Pharmaceuticals, Inc.; Euthymics Bioscience, Inc.; Fabre-Kramer Pharmaceuticals, Inc.; Forest Pharmaceuticals, Inc.; GenOmind, LLC; GlaxoSmithKline; Grunenthal GmbH; i3 Innovus/Ingenis; Janssen Pharmaceutica; Jazz Pharmaceuticals, Inc.; Johnson & Johnson Pharmaceutical Research & Development, LLC; Knoll Pharmaceuticals Corp.; Labopharm Inc.; Lorex Pharmaceuticals; Lundbeck Inc.; MedAvante, Inc.; Merck & Co., Inc.; MSI Methylation Sciences, Inc.; Naurex, Inc.; Neuronetics, Inc.; NextWave Pharmaceuticals; Novartis AG; Nutrition 21; Orexigen Therapeutics, Inc.; Organon Pharmaceuticals; Otsuka Pharmaceuticals; PamLab, LLC.; Pfizer Inc.; PharmaStar; Pharmavite® LLC.; PharmoRx Therapeutics; Precision Human Biolaboratory; Prexa Pharmaceuticals, Inc.; Puretech Ventures; PsychoGenics; Psylin Neurosciences, Inc.; Rexahn Pharmaceuticals, Inc.; Ridge Diagnostics, Inc.; Roche; RCT Logic, LLC; Sanofi-Aventis US LLC.; Sepracor Inc.; Servier Laboratories; Schering-Plough Corporation; Solvay Pharmaceuticals, Inc.; Somaxon Pharmaceuticals, Inc.; Somerset Pharmaceuticals, Inc.; Sunovion Pharmaceuticals; Supernus Pharmaceuticals, Inc.; Synthelabo; Takeda Pharmaceutical Company Limited; Tal Medical, Inc.; Tetragenex Pharmaceuticals, Inc.; TransForm Pharmaceuticals, Inc.; Transcept Pharmaceuticals, Inc.; Vanda Pharmaceuticals, Inc.

Speaking/Publishing: Adamed, Co; Advanced Meeting Partners; American Psychiatric Association; American Society of Clinical Psychopharmacology; AstraZeneca; Belvoir Media Group; Boehringer Ingelheim GmbH; Bristol-Myers Squibb; Cephalon, Inc.; CME Institute/Physicians Postgraduate Press, Inc.; Eli Lilly and Company; Forest Pharmaceuticals, Inc.; GlaxoSmithKline; Imedex, LLC; MGH Psychiatry Academy/Primedia; MGH Psychiatry Academy/Reed Elsevier; Novartis AG; Organon Pharmaceuticals; Pfizer Inc.; PharmaStar; United BioSource,Corp.; Wyeth-Ayerst Laboratories

Equity Holdings: Compellis

Royalty/Patent, Other Income: Patent for Sequential Parallel Comparison Design (SPCD) and patent application for a combination of azapirones and bupropion in Major Depressive Disorder (MDD), copyright royalties for the MGH Cognitive & Physical Functioning Questionnaire (CPFQ), Sexual Functioning Inventory (SFI), Antidepressant Treatment Response Questionnaire (ATRQ), Discontinuation-Emergent Signs & Symptoms (DESS), and SAFER. Patent for research and licensing of SPCD with RCT Logic; Lippincott, Williams & Wilkins; Wolkers Kluwer; World Scientific Publishing Co. Pte.Ltd.

All other authors have no conflict of interest to disclose.


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Copyright information

© The Society of Behavioral Medicine (outside the USA) 2013

Authors and Affiliations

  • Christopher B. Harte
    • 1
    • 2
  • Gabrielle I. Liverant
    • 1
    • 2
  • Denise M. Sloan
    • 1
    • 2
    • 3
  • Barbara W. Kamholz
    • 1
    • 2
    • 4
  • Laina E. Rosebrock
    • 1
  • Maurizio Fava
    • 5
    • 6
  • Gary B. Kaplan
    • 1
    • 2
  1. 1.VA Boston Healthcare SystemBostonUSA
  2. 2.Boston University School of MedicineBostonUSA
  3. 3.National Center for PTSDBostonUSA
  4. 4.Boston UniversityBostonUSA
  5. 5.Massachusetts General HospitalBostonUSA
  6. 6.Harvard Medical SchoolBostonUSA

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