Heart rate variability and treatment outcome in major depression: a pilot study

Int J Psychophysiol. 2014 Aug;93(2):204-10. doi: 10.1016/j.ijpsycho.2014.04.006. Epub 2014 Apr 24.


Variations in heart rate variability (HRV) have been associated with major depressive disorder (MDD), but the relationship of baseline HRV to treatment outcome in MDD is unclear. We conducted a pilot study to examine associations between resting baseline HRV and MDD treatment outcome. We retrospectively tested several parameters of HRV in an MDD treatment study with escitalopram (ESC, N=26) to generate a model of how baseline HRV related to treatment outcome, and cross-validated the model in a separate trial of MDD treatment with Iyengar yoga (IY, N=16). Lower relative power of very low frequency (rVLF) HRV at baseline predicted improvement in depressive symptoms when adjusted for age and gender (R2>.43 and p<0.05 for both trials). Although vagal parasympathetic measures were correlated with antidepressant treatment outcome, their predictive power was not significant after adjusting for age and gender. In conclusion, baseline resting rVLF was associated with depression treatment outcome in two independent MDD treatment studies. These results should be interpreted with caution due to limited sample size, but a strength of this study is its validation of the rVLF predictor in an independent sample. rVLF merits prospective confirmation as a candidate biomarker.

Keywords: Escitalopram; Heart rate variability; Major depressive disorder; Selective serotonin reuptake inhibitor; Very low frequency; Yoga.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use*
  • Citalopram / therapeutic use*
  • Depressive Disorder, Major* / drug therapy
  • Depressive Disorder, Major* / physiopathology
  • Depressive Disorder, Major* / rehabilitation
  • Electrocardiography
  • Female
  • Heart Rate / drug effects
  • Heart Rate / physiology*
  • Humans
  • Male
  • Middle Aged
  • Mind-Body Therapies / methods*
  • Pilot Projects
  • Treatment Outcome*
  • Yoga


  • Antidepressive Agents
  • Citalopram