Influence of Initial Severity of Depression on the Effectiveness of a Multimodal Therapy on Depressive Score, Heart Rate Variability, and Hemodynamic Parameters

Depression is a major cause of disability among populations worldwide. Apart from primary symptoms, depressed patients often have a higher cardiovascular risk profile. Multimodal therapy concepts, including exercise, have emerged as promising approaches that not only improve depressive symptoms but also have a positive impact on cardiovascular risk profile. However, controversies have arisen concerning the influence of baseline severity on the effects of therapy concepts for this demographic. This study assessed whether pretreatment severity moderates psychological and physiological treatment outcomes of a multimodal therapy. A total of 16 patients diagnosed with mild depression (MD) and 14 patients diagnosed with severe depression (SD) took part in a 3-month outpatient multimodal treatment therapy. Before and after the treatment, depression score (Beck Depression Inventory (BDI)), peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), heart rate (HR), and parasympathetic parameters of heart rate variability (RMSSD) were assessed. Significant time effects were detected for BDI (-20.0 +/- 11.6, p > 0.001, eta(2) = 0.871), pSBP (-4.7 +/- 6.8 mmHg, p < 0.001, eta(2) = 0.322), pDBP (-3.5 +/- 6.9 mmHg, p = 0.01, eta(2) = 0.209), cSBP (-4.8 +/- 6.5 mmHg, p < 0.001, eta(2) = 0.355), cDBP (-3.6 +/- 6.8 mmHg, p = 0.008, eta(2) = 0.226), PWV (-0.13 +/- 0.23 m/s, p = 0.008, eta(2) = 0.229), HR (4.3 +/- 8.8 min(-1), p = 0.015, eta(2) = 0.193), RMSSD (-12.2 +/- 23.9 ms, p = 0.017, eta(2) = 0.251), and and SDNN (10.5 +/- 17.8 ms, p = 0.005, eta(2) = 0.330). Significant time x group interaction could be revealed for BDI (p < 0.001, eta(2) = 0.543), with patients suffering from SD showing stronger reductions. Pretreatment severity of depression has an impact on the effectiveness of a multimodal therapy regarding psychological but not physiological outcomes.