Depression and cardiovascular reactions to acute psychological stress: Is anhedonia the driver?

Blunted cardiovascular reactions in response to acute psychological stress are predictive of future health risk. A large body of research has identified depression as an influential factor associated with blunted cardiovascular reactivity. Separately, there has been a resurgence in focus on anhedonia as a key feature of depression, responsible for poor treatment responses to non-improvement in cardiac event-free survival. In a re-analysis of a previously published study that found depression to be associated with blunted systolic blood pressure (SBP) and heart rate responses (HR), we used cross-sectional network models to examine if anhedonia symptoms were key drivers of this observation. Healthy young adults (N = 180) completed measures of depression symptoms (Hospital Anxiety and Depression Scale (HADS)) and had their blood pressure and heart rate monitored throughout a standardized stress testing protocol. Using network analysis, a Walktrap algorithm identified two clusters of depressive symptoms: anhedonia and non-anhedonia. These anhedonia symptoms of depression, but not the non-anhedonia symptoms, were associated with blunted SBP and HR reactivity, such that those scoring higher on HADS-D items capturing anhedonia displayed more blunted cardiovascular response profiles. Moreover, these findings were robust to adjustment for several covariates. This study adds greater clarity on the depression-cardiovascular reactivity to stress association, by demonstrating that anhedonia is a key driver of this observation.