title: Depression and type A behavior pattern in patients with coronary artery disease: relationships to painful versus silent myocardial ischemia and beta-endorphin responses during exercise.
abstract: A sample of 45 patients with a history of coronary heart disease and documented myocardial ischemia during exercise testing were evaluated in an investigation of the possible relationships between psychological factors (depression and Type A behavior pattern), plasma beta-endorphin response and pain experience during maximal exercise-induced ischemia. Depression was assessed using the MMPI-D subscale, while Type A was evaluated using the Structured Interview. All patients developed ischemia during exercise as defined by ST-segment depression; however, only 18 patients reported anginal pain. Patients with high depression scores (MMPI-D greater than or equal to 70; n = 13) showed lesser increases in plasma beta-endorphin levels, tended more often to report anginal pain and rated pain as more severe during exercise than patients with low depression scores (MMPI-D less than 60; n = 18). Hemodynamic responses and severity of ischemia (assessed by ejection fraction changes and wall-motion abnormalities) did not differ between depression groups. Even after adjustment for group differences in exercise duration, depression was significantly associated with a lesser beta-endorphin response in the sample as a whole and, among patients reporting angina, with earlier pain onset and greater pain duration and severity. In contrast, when Type A versus B/X subgroups were compared, no differences in pain experience, beta-endorphin response or measures of ischemia were obtained. These findings suggest that in patients with ischemic heart disease, there may be a relationship between depression and anginal pain which may in part involve a blunted or absent beta-endorphin response.
authors.affiliation: University of North Carolina, Chapel Hill 27599.
authors.forename: K C
authors.initials: KC
authors.lastname: Light
authors.forename: M C
authors.initials: MC
authors.lastname: Herbst
authors.forename: E E
authors.initials: EE
authors.lastname: Bragdon
authors.forename: A L
authors.initials: AL
authors.lastname: Hinderliter
authors.forename: G G
authors.initials: GG
authors.lastname: Koch
authors.forename: M R
authors.initials: MR
authors.lastname: Davis
authors.forename: D S
authors.initials: DS
authors.lastname: Sheps
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000523:psychology*; D003327:Coronary Disease / Q000097:blood* / Q000523:psychology*; D003863:Depression / Q000097:blood* / Q000523:psychology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008950:MMPI / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011594:Psychometrics; D014434:Type A Personality; D001615:beta-Endorphin / Q000097:blood*
chemical_list: D001615:beta-Endorphin