Anxiety and depressive disorders ar...

Anxiety and depressive disorders are particularly everyday in patients with cardiovascular disease. common study showed that one week after myocardial infarction, an estimated 16 percent of patients met the criteria for a major depressive disorder. Other studies have establish an association between coronary artery disease and hypertension and anxiety disorders. Davies and colleagues reviewed biologic explanations for the increased prevalence of depression and anxiety in patients with cardiovascular disease. They also studied the evidence for optimal pharmacologic and psychotherapeutic treatment of these psychiatric conditions in patients with cardiovascular disease.

springs of one study showed that mortality in reduceed patients is 3.5 times greater than that in nondepressed patients following myocardial infarction; however, the association between psychiatric morbidity and cardio-vascular disease goe beyond the psycho-logic impact of heart disease. Several studies report a prospective association between anxiety disorders and the later progress to maturity of cardiovascular disease or quick death. Depression also has been linked with the disclosure of cardiovascular complications in patients with hypertension. Several biologic explanations have been propos for the association between psychiatric and cardiovascular disease, including a serotonin-mediated power on platelets and dysfunction of the autonomic nervous order Psychologic symptoms may impair coping mechanisms and the ability to adhere to lifestyle changes and medication regimens. Finally, patients whose cardiovascular symptoms, so as dyspnea or chest pain, are attributed to anxiety or panic disorders may have a delay in diagnosis and increased morbidity because of treatment initiation when cardio-vascular disease is advanced.

Certain unsalable article treatments for psychiatric morbidity have been associated with a reduc incidence of myocardial infarction and an improved survival rate in patients who had unstable angina or myocardial infarction. A case-control thought with 5,336 participants reported that the redundants ratio for myocardial infarction (059) was significantly reduc in patients who were receiving fluoxetine, sertraline, or paroxetine. At least five double-blind comparative or placebo-controlled trials support the efficacy of selective serotonin reuptake inhibitors (SSRIs) in patients who have depression and ischemic heart disease or hypertension. The largest trial construct significant improvement in depression scores in patients randomized to sertraline following hospital admission for myocardial infarction or unstable angina. Other studies construct evidence supporting the use of fluoxetine and citalopram. In common study of 56 patients, nortriptyline was superior to fluoxetine and placebo in remission of depressive symptoms. Nortriptyline may be les likely to cause hypotension and other adverse cardiac powers commonly associated with tricyclic drugs

mix with drugs interactions are particularly important in patients with cardiovascular and psychiatric conditions. These patients are likely to be receiving several medications, many of which are metabolized by the agency of the cytochrome P450 enzymes CYP2D6 and CYP3A4. Paroxetine and fluoxetine are able CYP2D6 inhibitors and can interfere with the metabolism of propranolol, metoprolol, flecainide, and encainide. reciprocally fluoxetine and nefazodone inhibit CYP3A4 and may interfere with simvastatin, amlodipine, nifedipine, diltiazem, and amiodarone.

Cognitive behavior therapy is effective for depression and anxiety disorders and has been felicitous in patients with chest pain unless not in patients with cardiac disease. This therapy has not been prov to resolve into cardiac events in patients with poor social supports.

The authors stres the ne for physicians to recognize and effectively treat anxiety and depression in patients with cardiovascular disease. The accumulating evidence of effectiveness indicates that diagnosis and management of psychiatric morbidity should be incorporated into all clinical management of coronary heart disease and hypertension.

Davies SJ et al. Treatment of anxiety and depressive disorders in patients with cardiovascular disease. BMJ April 17 2004;328:939-43

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group