title: Depression and anxiety in patients with hereditary angioedema.
abstract: BACKGROUND
  Hereditary angioedema (HAE) is characterized by edematous swelling attacks of the face, extremities, abdomen, genitalia, and upper airway. The potential for laryngeal swelling makes the disease life-threatening, and the swelling elsewhere contributes to the significant burden of illness. The increased risk for mental health disorders in HAE is due to the burden of disease and possibly associated activation of the immune system.
  
  
  OBJECTIVE
  To determine the prevalence of depression and anxiety in HAE patients and the most high-yield features of depression to target in a clinical encounter.
  
  
  METHODS
  Depression and anxiety symptoms were evaluated using the 29 items of the Hamilton Depression Rating Scale along with the 14-item Hamilton Anxiety Rating Scale. The sample size was 26 participants with a diagnosis of type 1 or 2 HAE drawn from a cohort of 60 adult patients. In addition, a literature search was performed regarding how immune modulation affects depression and anxiety.
  
  
  RESULTS
  A total of 39% of participants were identified as experiencing depression of mild (50%), moderate (40%), or severe (10%) levels. Fifteen percent of participants displayed prominent anxiety, half of whom had mild anxiety, 25% moderate anxiety, and 25% severe anxiety. The literature on inflammation and depression suggests a possible link between HAE and depression.
  
  
  CONCLUSIONS
  Our data and the literature support that depression and anxiety symptoms are common in patients with HAE and may be secondary to chronic disease burden, associated pathophysiologic features, or both. Treatment that addresses the psychosocial and mental health of HAE patients is critical for best practice.
authors.affiliation: College of Medicine, Penn State University, Hershey, Pennsylvania.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Fouche
authors.affiliation: Department of Psychiatry, Penn State University Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Erika F H
authors.initials: EF
authors.lastname: Saunders
authors.affiliation: Department of Medicine and Pediatrics, Penn State University Hershey Medical Center, Hershey, Pennsylvania. Electronic address: tcraig@psu.edu.
authors.forename: Timothy
authors.initials: T
authors.lastname: Craig
mesh_terms: D000328:Adult; D054179:Angioedemas, Hereditary / Q000453:epidemiology*; D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015213:Neuroimmunomodulation; D015995:Prevalence; D011788:Quality of Life; D013732:Test Anxiety Scale