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Depression, Anxiety Bad for the Heart
Two new studies show effects on angina and mortality

(HealthDay News) -- Two new studies show that problems with the mind can play a significant role in problems of the heart.

One study found that anxiety and depression can increase the incidence of angina, the chest pain that sends many people to the doctor, said Dr. Mark Sullivan, professor of psychiatry and behavioral sciences at the University of Washington, and senior author of one of the reports in the June 29 online issue of Circulation.

"The overwhelming focus in the United States has been on ischemia," the blockage of heart arteries, Sullivan said. "That is pretty unique in the world. The rest of the world takes a much more multi-modal approach to chest pain. Ischemia is not the only or most important cause of what patients are feeling."

Stress tests and similar measures are properly used to assess ischemia in people with angina, Sullivan said. "But in addition to the kind of diagnostic studies done with stress tests, patients who have a lot of angina should be screened for anxiety and depression, because they could be very cost-effective targets for intervention," he said.

To prove that point, Sullivan and his colleagues studied 191 people with known ischemia who underwent stress testing and heart imaging. They found that 36 percent reported no angina in the previous month, with 35 percent reporting monthly incidents.

Of the 30 percent who had daily or weekly angina, psychological assessments, including a self-reporting anxiety and depression questionnaire, showed that 44 percent had significant anxiety and two-thirds had significant depression.

It's not clear whether the psychological problems were heightening the effect of angina or vice versa, Sullivan said. What is clear is that physicians treating people with angina can use "fairly simple screening tests" to determine the presence of anxiety or depression and treat those conditions if necessary, he said.

"This is something many cardiologists tend not to be comfortable with," Sullivan said, so another physician could be called in to handle the problem. Referral to a psychiatrist is not necessary, because "at this point in time most primary-care physicians are comfortable with making an initial trial with treatment," he said.

The new study was not designed to show whether treatment by such measures as antidepressants could relieve chest pain, Sullivan said, but his group is considering such a trial.

Another report in the journal linked depression with poor outcomes for people with both heart failure, the progressive loss of ability to pump blood, and the abnormal heart rhythm called atrial fibrillation.

"Many studies have shown that depression is a predictor of mortality after a heart attack or in congestive heart failure," said study author Nancy Frasure-Smith, a senior research associate at the Montreal Heart Institute. "Most studies have shown that differences in severity of heart disease between people who are depressed or not depressed do not account for the difference. One hypothesis is that people who are depressed don't get as good treatment for their heart disease."

To test that hypothesis, Frasure-Smith and her colleagues assessed 974 people with heart disease for depression -- which was found in 32 percent of them -- and then assigned them to get either standard medical care or a heightened degree of care.

The study showed that "depression is at least an indicator of patients who are at higher risk of mortality even when given the best care we know how to," Frasure-Smith said.

Nevertheless, the case against extra care for such people is not proven because "there are no trials assessing treatment for depression in people with congestive heart disease and atrial fibrillation," she said. "Newer antidepressants are more effective, and if you give these people extra care, they may get better."

More information

Depression and its treatment are described by the U.S. National Institute of Mental Health.

SOURCES: Mark Sullivan, M.D., Ph.D., professor, psychiatry and behavioral sciences, University of Washington, Seattle; Nancy Frasure-Smith, Ph.D., senior research associate, Montreal Heart Institute; June 29, 2009, Circulation, online

Last Updated: June 29, 2009

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