Effect of medication and psychotherapy on heart rate variability in panic disorder

Amir Garakani, Jose M. Martinez, Cindy J. Aaronson, Andrei Voustianiouk, Horacio Kaufmann, Jack M. Gorman

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Background: Panic disorder (PD) patients have been shown to have reduced heart rate variability (HRV). Low HRV has been associated with elevated risk for cardiovascular disease. Our aim was to investigate the effects oftreatment on heart rate (HR) in patients with PD through a hyperventilation challenge. Methods: We studied 54 participants, 43 with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) PD and 11 controls. Subjects lay supine with their heads in a plastic canopy chamber, resting for 15min and then breathing at a rate of 30 breaths per minute for 10min. HRV was sampled for spectral analysis. Clinical and behavioral measures of anxiety were assessed. Treatment was chosen by patients: either 12 weeks of CBT alone or CBTwith sertraline. Results: All patients showed significant decrease on clinical measures from baseline and 31 were treatment responders, 8 dropped out of the study before completion of the 12-week treatment phase and 4 were deemed nonresponders after 12 weeks oftreatment. Although both treatments led to significant clinical improvement, only CBT alone demonstrated a significant reduction in HR and increase in HRV. Conclusions: Our study replicated the findingthat increased HR and decreased HRVoccur in PD patients. Given the evidence ofcardiac risk related to HRV, CBTappears to have additional benefits beyond symptom reduction. The mechanisms of this difference between CBT and sertraline are unclear and require further study.

Original languageEnglish
Pages (from-to)251-258
Number of pages8
JournalDepression and Anxiety
Issue number3
StatePublished - Mar 2009


  • Anxiety
  • Breathing
  • Cardiac
  • Cognitive behavioral therapy
  • Life stress
  • SSRI


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