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Preliminary Results of an Open Label Study of Heart Rate Variability Biofeedback for the Treatment of Major Depression

Abstract

Major depressive disorder (MDD) is a common mood disorder that can result in significant discomfort as well as interpersonal and functional disability. A growing body of research indicates that autonomic function is altered in depression, as evidenced by impaired baroreflex sensitivity, changes in heart rate, and reduced heart rate variability (HRV). Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in participants with MDD, and baroreflex gain is decreased. Study objectives: To assess the feasibility of using HRV biofeedback to treat major depression. Design: This was an open-label study in which all eleven participants received the treatment condition. Participants attended 10 weekly sessions. Questionnaires and physiological data were collected in an orientation (baseline) session and Treatment Sessions 1, 4, 7 and 10. Measurements and results: Significant improvements were noted in the Hamilton Depression Scale (HAM-D) and the Beck Depression Inventory (BDI-II) by Session 4, with concurrent increases in SDNN, standard deviation of normal cardiac interbeat intervals) an electrocardiographic estimate of overall measure of adaptability. SDNN decreased to baseline levels at the end of treatment and at follow-up, but clinically and statistically significant improvement in depression persisted. Main effects for task and session occurred for low frequency range (LF) and SDNN. Increases in these variables also occurred during breathing at one’s resonant frequency, which targets baroreflex function and vagus nerve activity, showing that subjects performed the task correctly Conclusions: HRV biofeedback appears to be a useful adjunctive treatment for the treatment of MDD, associated with large acute increases in HRV and some chronic increases, suggesting increased cardiovagal activity. It is possible that regular exercise of homeostatic reflexes helps depression even when changes in baseline HRV are smaller. A randomized controlled trial is warranted.

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Notes

  1. 1.

    Reason for termination was relocation.

  2. 2.

    Within the initial five sessions, one participant was diagnosed with a medical condition; the other participant stated no longer feeling symptomatic and did not feel it was necessary to continue.

  3. 3.

    Heart rate is influenced by antidepressant medication. Tricyclics routinely increase heart rate by 11% and decreased HRV while some selective serotonin reuptake inhibitors (SSRI) decrease heart rate slightly and increase HRV (Quitkin, Rabkin, Gerald, Davis, & Klein, 2000; Roose, 2003). It would have been inadvisable to have taken individuals off proven medication to test the efficacy of an unproven treatment.

  4. 4.

    13 ≥ HAM-D ≤ 22.

  5. 5.

    Although LF HRV can be influenced by both sympathetic and parasympathetic systems, we interpret the findings as suggesting greater parasympathetic activity, because, during biofeedback, people breathe at a frequency within the LF range. Thus, unique to this procedure, large increases in LF HRV during biofeedback reflect increases in respiratory sinus arrhythmia, hence, increases in vagus nerve traffic, particularly when data are controlled for respiration rate.

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Acknowledgments

These authors wish to thank Erin Arnold for her help in data analysis; and the Department of Psychiatry at the University of Medicine and Dentistry and NIH P20 MH074634 support (Multiple Unexplained Physical Symptoms in Primary Care Research Center).

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Correspondence to Maria Katsamanis Karavidas.

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Karavidas, M.K., Lehrer, P.M., Vaschillo, E. et al. Preliminary Results of an Open Label Study of Heart Rate Variability Biofeedback for the Treatment of Major Depression. Appl Psychophysiol Biofeedback 32, 19–30 (2007). https://doi.org/10.1007/s10484-006-9029-z

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Keywords

  • Vagus nerve
  • Depression
  • Heart rate variability
  • Biofeedback
  • Breathing