Generalized anxiety disorder, comorbid major depression and heart rate variability: A case-control study in Taiwan

Hsin An Chang, Chuan Chia Chang, Nian Sheng Tzeng, Terry B J Kuo, Ru Band Lu, San Yuan Huang

Research output: Contribution to journalArticlepeer-review

44 Citations (Scopus)


Objective Decreased heart rate variability (HRV) has been reported in generalized anxiety disorder (GAD), but the results are mixed. Little is known about the impact of comorbid major depression (MD) on HRV in GAD patients. Both issues necessitate further investigation. Methods Twenty unmediated, physically healthy GAD patients, 20 GAD patients with a secondary diagnosis of MD, 40 MD patients and 60 matched controls were recruited. We used the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale to assess anxiety and depression severity, respectively. Cardiac autonomic function was evaluated by measuring HRV parameters. Frequency-domain indices of HRV were obtained. Results Tree patient groups had more anxiety and depression symptoms than control subjects, but heart rates (HRs) were significantly elevated only in GAD patients with comorbid depression. Relative to controls, GAD patients had reduced HRV while GAD patients with comorbid depression displayed the greatest reductions in HRV among three patients groups. Correlation analyses revealed anxiety/depression severity significantly associated with HRs, variance, LF-HRV and HF-HRV. However, separately analyzing among individual groups and adjusting for HRV-associated co variables rendered the correlations non-significant. Conclusion Our results suggest that reduction in HRV is a psycho physiological marker of GAD and individuals with comorbid GAD and MD may be distinguished based on psycho physiological correlates (for example, HF-HRV) from non-co morbid GAD patients. Taken into account that co morbid depression may confer increased risks for cardiovascular events in GAD patients, this subgroup of GAD patients may benefit better from cardiovascular risk reduction strategies.

Original languageEnglish
Pages (from-to)326-335
Number of pages10
JournalPsychiatry Investigation
Issue number4
Publication statusPublished - Dec 2013
Externally publishedYes


  • Cardiac autonomic function
  • Generalized anxiety disorder
  • Heart rate variability
  • Major depression
  • Vagal control

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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