Differences in anxiety, depression, and heart rate variability between patients with methamphetamine use disorder and heroin use disorder patients on methadone maintenance treatment

Long-term substance abuse is associated with impairments in both psychological well-being and physiological indicators in patients. However, the mechanisms of impairment may differ between patients with Methamphetamine Use Disorder (MUD) and those with Heroin Use Disorder (HUD) receiving Methadone Maintenance Treatment (MMT). This study compared differences in anxiety, depression, and Heart Rate Variability (HRV) among patients with MUD, patients with HUD on MMT, and healthy controls (HCs), and examined whether these differences were associated with craving and treatment-intensity variables. Forty patients with MUD, Fifty patients with HUD receiving MMT, and fifty HCs were recruited. Psychological indicators were assessed using the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). Physiological indicators were assessed using HRV. Group differences were examined, and correlations between these indicators and both daily MMT dosage and craving scores were evaluated. Compared with the HC group, both the HUD and MUD groups had significantly higher SAS and SDS scores and LFn, but lower HFn. The MUD group also showed significantly higher SAS and SDS scores, higher LFn, and LF/HF ratio, and lower HFn than the HUD group. Correlation and stepwise regression analyses indicated that SAS and SDS scores were independently associated with the daily MMT dosage in the HUD group. In the MUD group, SDS scores and the root mean square of successive differences (RMSSD) were independently associated with craving scores. Participants were categorized into Low-Risk and High-Risk groups based on median splits. Analysis of variance (ANOVA) showed that the High-Risk MUD subgroup had higher depression levels, with SDS scores exceeding those of the other three groups. Furthermore, both Low-Risk and High-Risk HUD subgroups demonstrated higher HFn and lower LFn than their MUD counterparts, suggesting more stable autonomic nervous system (ANS) function in HUD patients. Subsequent correlation analysis found that in the High-Risk HUD subgroup, SDS and SAS scores remained significantly correlated with daily MMT dosage, whereas no such correlations were observed in the Low-Risk HUD subgroup. In the MUD group, craving in the High-Risk subgroup was significantly correlated only with SDS scores, not with HRV parameters. However, in the Low-Risk MUD subgroup, mean heart rate (HR) was correlated with craving. Finally, demographic variables (marital status and years of education) were associated with daily MMT dosage in the HUD group, but not in the MUD group. Both methamphetamine and heroin dependence were associated with anxiety, depression, and altered HRV. Compared with HUD patients receiving MMT, patients with MUD demonstrated more severe anxiety and depression and greater ANS dysregulation. Importantly, ANS dysfunction and emotional symptoms were differentially associated with daily MMT dosage requirements in HUD patients and with craving levels in those with MUD, highlighting the need for tailored interventions that target these psychophysiological mechanisms.