Heart rate variability in unmedicated patients with bipolar disorder in the manic phase

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

41 Citations (Scopus)


Aims Decreased heart rate variability (HRV) has been proposed in bipolar disorder. To date, there has been no adequate study that has investigated resting HRV in unmedicated patients with bipolar disorder in the manic state. Methods To examine whether bipolar mania is associated with decreased HRV, 61 unmedicated patients with bipolar mania and 183 healthy volunteers aged 20-65 years were recruited for this case-control analysis. The Young Mania Rating Scale (YMRS), Clinical Global Impression-Severity, Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used for the clinical ratings. Cardiac autonomic function was evaluated by measuring HRV parameters and the frequency-domain indices of HRV were obtained. Results Patients with bipolar mania exhibited significantly lower mean RR interval, variance, low-frequency (LF)-HRV, and high-frequency (HF)-HRV but higher LF/HF compared to controls. Decreased HRV (variance) was associated with the YMRS total scores. Both the YMRS total scores and the Clinical Global Impression-Severity scores were positively correlated with the LH/HF ratio and inversely correlated with the HF-HRV. There was no significant correlation between the HAM-D/HAM-A scores and any HRV parameter. Conclusions Bipolar mania is associated with cardiac autonomic dysregulation, highlighting the importance of assessing HRV in manic patients. Further studies examining the influence of anti-manic psychotropic drugs on cardiac autonomic regulation in bipolar mania are needed.

Original languageEnglish
Pages (from-to)674-682
Number of pages9
JournalPsychiatry and Clinical Neurosciences
Issue number9
Publication statusPublished - 2014
Externally publishedYes


  • bipolar disorder
  • cardiac autonomic function
  • heart rate variability
  • mania
  • vagal control

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Psychiatry and Mental health
  • General Neuroscience
  • General Medicine


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