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Anxiety Reduces Baroreflex Cardiac Control in Older Adults With Major Depression

From the Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina (L.L.W., R.K., J.A.B.); and Hebrew Rehabilitative Center for the Aged, Boston, Massachusetts (P.G.).

Address reprint requests to: Dr. Lana Watkins, Department of Psychiatry and Behavioral Sciences, Box 3119, Duke Medical Center, Durham, NC 27710. Email: watkins1{at}mail-wa.acpub.duke.edu

OBJECTIVE: Although depression and anxiety predict risk of cardiac mortality, the contributions of depression and anxiety to vagal cardiac control have not been systematically evaluated. The goal of this study was to examine the relationship between state anxiety and vagal control of heart rate in older adults with major depressive disorder (MDD). Older adults (50–70 years old) were selected for this study because of the greater cardiac risk associated with low vagal cardiac control across this age range.

METHODS: Fifty-six men and women with MDD were evaluated. MDD was diagnosed using the Diagnostic Interview Schedule, and severity of depression was measured using the Beck Depression Inventory and the Hamilton Rating Scale for depression. State anxiety was measured using the Spielberger State Anxiety Inventory. Power spectral analysis was used to measure two indices of vagal control: baroreflex control of heart rate (BRC_SPEC) and respiratory sinus arrhythmia (RSA).

RESULTS: State anxiety was negatively correlated with levels of BRC_SPEC (r = -0.32, p < .05), whereas depression severity was not related to either RSA or BRC_SPEC. Furthermore, BRC_SPEC was reduced by approximately 33% in MDD patients with state anxiety scores (ST-ANX) in the highest quartile (ST-ANX > 41, N = 13), compared with patients with ST-ANX scores in the lowest quartile (ST-ANX < 25, N = 14; p < .05).

CONCLUSIONS: Anxiety, but not depression severity, is associated with reduced BRC_SPEC in older men and women. Future studies are needed to determine whether comorbid anxiety contributes to the increased cardiovascular risk associated with MDD.

Key Words: baroreflex control of heart rate • respiratory sinus arrhythmia • spectral analysis • Spielberger State Anxiety Inventory • Beck DepressionInventory • Hamilton Rating Scale for Depression

Abbreviations: HR = heart rate; HRV = heart rate variability; CAD =coronary artery disease; MDD = major depressive disorder; RSA= respiratory sinus arrhythmia; BRC_SPEC = baroreflexcontrol of heart rate; BDI = Beck Depression Inventory; HRSD= Hamilton Rating Scale for Depression; ST-ANX = state anxietyscore; SBP = systolic blood pressure; DBP = diastolic bloodpressure; BMI = body mass index; bpm = beats per minute; BRC_PHEN = baroreflex sensitivity assessed withphenylephrine injection.

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