[Anxiety and depression in cardiology patients: how to diagnose, how to treat?].
OBJECTIVE
Anxiety and depression are frequent problems in patients with heart diseases. Prevalences vary between 15 and 50%, depending on diagnostic criteria as well as on sociodemographic and medical patient characteristics. During the last 10-15 years, a large number of studies have shown that anxiety and depression strongly affect overall well-being, cardiac and non-specific symptom reporting and overall quality of life. This leads to increased health care utilization, early retirement and imposes a financial burden on individuals and social security systems. In addition, anxious and especially depressed patients with heart disease tend to exhibit unhealthy illness behavior, low compliance and suboptimal risk factor control. Together with the known physiological effects of negative affect on cardiac autonomic balance, inflammation and platelet function, these behavioral mechanisms may lead to the frequently observed increase of cardiac event and mortality rates in depressed patients wit coronary artery disease.


METHODS
Despite their clinical relevance and unsatisfactory spontaneous remission rate, anxiety and depression still go unrecognized and undertreated in most cardiac patients. Case-identification can be improved by a graded approach. In the first step, symptoms of anxiety and depression should explicitly be asked for as part of a routine cardiological work-up. As an adjunct, validated self-rating questionnaires can be used for screening purposes. Patients screened positive should receive a thorough diagnostic interview and a criteria-based diagnosis.


METHODS
Once a diagnosis has been obtained, several treatment options are available: In less severe cases (minor depression or adjustment disorders), supportive care by primary care physicians or cardiologists may be sufficient. Patients with major depression or panic disorder should receive structured psychotherapy and/or antidepressant medication. Exercise training can also improve symptoms of anxiety and depression. Although both psychotherapy and antidepressants, especially if integrated in a concept of comprehensive cardiac care, can be expected to result in marked subjective benefit for the majority of patients, the impact of these treatments on cardiac event and mortality rates still needs to be determined.
Herrmann-Lingen
C
C
Klinik für Psychosomatik und Psychotherapie, Universität Göttingen. cherrma@gwdg.de
D000928:Antidepressive Agents / Q000627:therapeutic use; D001007:Anxiety; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006331:Heart Diseases / Q000209:etiology / Q000523:psychology*; D006801:Humans; D011379:Prognosis; D011613:Psychotherapy; D011788:Quality of Life
D000928:Antidepressive Agents