Depression and HRV Biofeedback
Depresssion is common but it's etiology and pathophysiology are not clear. There are complex interactions going on between psychological and physiological factors.
It's a problem of mind AND body but we don't know which is the source of the depression. That sounds crazy in "conventional" terms about what it is about us that thinks. Doesn't that have to be the brain?
Research has shown that far from the brain always being the "master controller," it is more that the brain is responsible for hosting conversations between the various organ systems. In many ways the body thinks too. Many of us that feel "off balance" or "down in the dumps" can shake off that feeling by exercise or engaging our bodies in some activity. Severe depression is different of course and sufferers may feel powerless to do anything and yet the same mind-body connection that helped with the blues is still there. Could biofeedback provide a more powerful way of beneficially exploiting this mind-body, two way, connection to help with depression?
We do know that common treatment approaches - whether pharmacological or psychotherapy are not always effective; typically some 10 to 15% of persons with major depressive disorders remain depressed despite treatment.
Autonomic nervous system (ANS) dysfunction is thought to play a sigificant role in depression but the mechanisms are not clear. Symptoms of sleep disturbance, fatigue, increased heart rate, decreased vagal tone and sympathetic nervous system arousal are often found which suggest ANS dysfunction. Depression may arise due to a dysfunctional response to emotional stress but also may have no identifiable cause. Reseach is needed to provide evidence whether ANS dysfunction is a cause, an effect or epiphenomenon of severe depression.
If there is a causative link between ANS dysfunction and depression then various forms of biofeedback and neurofeedback might well be helpful. Certainly, if biofeedback can be helpful this would be a great addition to the clinician's approach to depression by direct impact and by boosting the effects of other forms of treatment.
Katsamanis (2016)reports on studies using heart rate variability (HRV) biofeedback for major depresssion. We have written about HRV biofeedback in other articles and therefore won't repeat all the basic information on this approach here.
HRV training involves guiding the client's breathing (usually slowing it) to a point at which the heart rate variability is maximised and the baroreflex is stimulated. This breathing rate is typically around six breaths per minute but can vary from person to person. With biofeedback training the client learns to synchronise their breathing with the speeding up and slowing down of the heart beat. This has significant beneficial effects on blood pressure, sympathetic nervous system activation and indeed overall cardio and ANS balance. The stimulation of the vagus nerve which is produced seems to help serious depression that has been unresponsive to antidepressent medication.
In their study, the author reports effects on major depression that seemed to be stronger than those produced by most SSRIs.
Kasamanis, M. "Heart rate variability biofeedback for major depression"
Chapter 12 in Foundations of heart rate variability biofeedback: A book of readings.
AAPB 2016. ISBN 978-0-9842979-5-5
See also Katsamanis et al (2007) Preliminary Results of an Open Label Study of Heart Rate Variability Biofeedback for the Treatment of Major Depression.
Applied Psychophysiology and Biofeedback, March 2007, Volume 32, Issue 1, pp 19–30
Siepmann, M et al (2008) "A Pilot Study on the Effects of Heart Rate Variability Biofeedback in Patients with Depression and in Healthy Subjects".
Applied Psychophysiology and Biofeedback, December 2008, Volume 33, Issue 4, pp 195–201
I-Mei Lin et al (2018) "Heart rate variability biofeedback increased autonomic activation and improved symptoms of depression and insomnia among patients with major depression disorder"
Clinical Psychopharmacology and Neuroscience, 2018; 16(3): 235~360