Effect Of Heart Rate Variability-biofeedback On Patients With Major Depressive Disorder

Objectives:?To investigate the relationship between heart rate variability and the score of depressive symptom severity, positive and negative emotions and the automatic thoughts of patients with major depressive disorder.?To assess the feasibility and clinical efficiency of using the heart rate variability-biofeedback to treat major depressive disorder. And explore whether such a behavioural neurocardiac intervention could influence on autonomic functions and mood in patients with depression.Methods: ?The heart rate variability analysis facility was used to collect heart rate and analyze the time-domain and frequency-domain parameters(HR, SDNN,RMSSD, HF, LF, VLF, TP, LF/HF) of heart rate variability in 80 patients with major depressive disorder. At the same time, the Hamilton Depression Scale (HAMD),Positive and Negative Emotional Scale (PANAS) , Automatic thoughts questionnaire(ATQ) score were evaluated, then the correlation analysis was performed on the scale scores and heart rate variability index .?In the randomized controlled study, the patients were randomly divided into the feedback group and the control group. Both groups were treated with the SSRI antidepressant medicine fluoxetine. The feedback group was also involved in heart rate variability biofeedback therapy for 30 minutes each day and last for 6 weeks.Six weeks after the intervention,both groups of patients were asked to complete the scale scores evaluation and the heart rate variability data collection,in order to assess the efficacy of treatment.Results: ?Tome data of the heart rate and heart rate variability parameters do not conform to the normal distribution,so we transform the data to Lg conversion.Lg(HR) was negatively correlated with positive emotion score(r = -0.297, p =0.007),and positively correlated with automatic thought score(r = 0.251, p = 0.025).Lg(RMSSD) was positively correlated with positive emotion score( r = 0.254, p =0.023). Lg(HF) was positively correlated with positive emotion score( r = 0.225, p =0.045).The other parameters of heart rate variability were not significantly related to HAMD scores, positive and negative emotions scores and automatic thoughts scores.After control of age and BMI index,Lg(HF) was not significantly correlated with positive emotion score. ? There was no significant differences in HAMD score,positive emotion score(PA), negative emotion score(NA) and automatic thoughts score(ATQ) between the feedback group and the control group on the baseline before treatment. After six weeks of treatment, the PA score of the feedback group was significantly higher than that of the control group(t = 3.188, p = 0.002), the differences between the two groups of the other scores were not statistically significant. The scores of HAMD, NA and ATQ in the feedback group and the treatment group were both significantly lower than those on the baseline,t value were 14.498vs12.455,5.983vs5.521,12.957vs18.721,respectively,all of the p value were<0.001.The PA score of feedback group was significantly higher than the baseline( t ?-5.685, p <0.001), the control group was no statistically significant difference. There was no significant difference of the HRV parameters between the two groups before treatment.After treatment the HF index of HRV frequency-domain parameter of the feedback group was significantly higher than baseline(Z = -2.254, p = 0.024), the ratio of LF / HF was significantly lower than baseline(Z = -3.253, p = 0.001). There was no statistically significant change in other parameters. The LF / HF ratio of the feedback group after 6 weeks of treatment was significantly lower than that of the control group(Z = -2.168, p = 0.029).Conclusions:? The heart rate variability time-domain index RMSSD was positively correlated with the positive score of the PANAS scale, suggesting that the inhibitory effect of the parasympathetic nerve system may be associated with positive regulation of emotion.Heart rate is negatively correlated with positive emotional scores and positively correlated with automatic thoughts questionnaire scores, which may be related to the physiological arouse of emotional responses.However, no significant correlation between negative emotions, automatic thoughts, and severity of depression symptoms were observed. Further studies of the correlation between HRV and related symptoms of major depressive disorder are needed to expand the sample.?Fluxetine monotherapy had no significant effect on heart rate variability in patients with major depressive disorder, bur HF of frequency-domin parameter of HRV was significantly lower in combination therapy of heart rate variability biofeedback and medicine, suggesting that HRVB treatment could improve autonomic nervous system dysfunction. The positive emotional scores of the combined heart rate variability biofeedback therapy group were significantly higher than those of the single drug therapy after 6 weeks of treatment, which indicated that HRVB had better effect on improving the positive emotion than that of the monotherapy. ?Heart rate variability Biofeedback therapy is a safe, convenient and effective treatment for major depressive disorder as a adjuvant therapy. Patients in the course of treatment consciously participate in the regulation of heart rate variability.This theropy not only help to improve the patient's ability to self-regulation,make improvement of depressive symptoms, while improving autonomic nervous system function, may reduce the risk of cardiovascular disease.The treatment is suitable for clinical application.HRV biofeedback appears to be a useful adjunct for the treatment of depression, associated with increases in HRV.