Depression and cardiovascular autonomic control: a matter of vagus and sex paradox

Eleonora Tobaldini, Angelica Carandina, Edgar Toschi-Dias, Luca Erba, Ludovico Furlan, Andrea Sgoifo, Nicola Montano

Research output: Contribution to journalReview articlepeer-review


Depression is a well-established stress-related risk factor for several diseases, mainly for those with cardiovascular outcomes. The mechanisms that link depression disorders with cardiovascular diseases (CVD) include dysfunctions of the autonomic nervous system. Heart rate variability analysis is a widely-used non-invasive method that can simultaneously quantify the activity of the two branches of cardiac autonomic neural control and provide insights about their pathophysiological alterations. Recent scientific literature suggests that sex influences the relationship between depressive symptoms and cardiac autonomic dysfunction. Moreover, a few studies highlight a possible sex paradox: depressed women, despite a greater vagal tone, experience a higher risk of adverse cardiovascular events than depressed men. Although there are striking sex differences in the incidence of depression, scanty data on this topic are available. Lastly, studies on the heart-brain axis bidirectionality and the role of sex are fundamental not only to clarify the biological bases of depression-CVD comorbidity, but also to develop alternative therapies, where vagus nerve appears to be a promising target of non-invasive neuromodulation techniques.

Original languageEnglish
Pages (from-to)154-161
Number of pages8
JournalNeuroscience and Biobehavioral Reviews
Publication statusPublished - Sep 2020


  • Cardiac autonomic control
  • Depression
  • Heart rate variability
  • Neuromodulation
  • Sex differences
  • Vagal stimulation

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience


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