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.
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.
Light
K C
KC
University of North Carolina, Chapel Hill 27599.
Herbst
M C
MC
Bragdon
E E
EE
Hinderliter
A L
AL
Koch
G G
GG
Davis
M R
MR
Sheps
D S
DS
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*
D001615:beta-Endorphin