Depression and anxiety in cardiovascular disease.

Research paper by Krzysztof Marek KM Małyszczak, Joanna J Rymaszewska

Indexed on: 11 May '16Published on: 11 May '16Published in: Kardiologia polska


Cardiovascular disease (CVD) and mental disorders often coexist. Mood and anxiety disorders are common in patients treated by general practitioners, where the prevalence of those disorders may be two times higher than in the general population (35%). Moreover, the prevalence rises up to 40% in patients suffering from cardiovascular disease. Observational studies revealed that depression caused an increased incidence of cardiovascular disease (CVD), and also increased the risk (1.2 to 2.7 fold) of incidents that led to cardiac-related, and all-cause death in patients with a history of CVD. There is not clear, whether prominent anxiety influence CVD significantly. For sure, its influence is not significant when it occurs together with depression, but may be important when anxiety occurs without depression. Unfortunately, the antidepressant treatment does not have an effect on the course of CVD nor on mortality in patients with CVD and concomitant depression. Out of tens studies carried out in different countries by different researchers using different methodologies, few revealed an effect of antidepressant treatment on the course of heart disease. Some of the studies showed mitigation of the severity of depression. Uniform conclusions concerning the safety of use of antidepressants in patients with CVD cannot be drawn based on the results of the studies. TCA were not found to be significantly harmful and SSRIs were not found to be completely safe. The only hamrful TCA proved to be dosulepine. Amitriptyline and imipramine, the most commonly used TCAs, showed similar effects on CVD as SSRIs. Most researchers questioned the safety of use of citalopram, escitalopram and fluoxetine. The remaining SSRIs and mianserine seemed safe to use. There have been few other studies focusing on other antidepressants. The screening of patients with CVD and the implementation of treatment is beneficial and should be routinely applied, because antidepressant treatment may be effective in the reduction of depression and may improve patient quality of life.