Depressed and single = chest pains

What do depression, chest pains, and being single have to do with each other? A study that followed up 191 patients with coronary artery disease (CAD) suggests that these three might be interrelated in this patient population. The results were based on answers to a questionnaire that determines the frequency of chest pain before and during physical stress testing as well as psychosocial assessments using a self reported anxiety and depression questionnaire.

Here are the key research findings:

• 36% reported no chest pain during the past month;
• 35% reported monthly symptoms of chest pains;
• 30% had daily or weekly chest pain
• 44% who reported daily or weekly chest pain had significant anxiety; two-thirds had severe depression.

The study results suggest that anxiety and depression are associated with higher incidence of angina pectoris among CAD patients, especially those who had surgical procedures to open blocked arteries.

Angina pectoris is mainly characterized by chest pain but can also include pain and discomfort in the jaw, shoulder, back and arm. The pain is caused by myocardial ischemia, a condition wherein the supply of oxygen-rich blood to the heart muscle is insufficient, which in CAD patients is mainly caused by narrowed or blocked arteries.

According to lead author Dr. Mark Sullivanof the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine in Seattle.

“This study has identified a high-risk group for angina. Patients with daily or weekly angina are highly likely to have significant anxiety and depression.”

Other findings of the study are:

• Patients who experienced angina more frequently were more likely to be younger and single.
• Patients who experienced chest pain more often were also more likely to report the pain during a treadmill testing.

The reason behind the link between the frequency of angina and depression , as well as age and civil status is not clear. According to Dr. Sullivan

“It is unclear whether these psychosocial factors are truly affecting the anginal response to ischemia or if the increased chest pain burden is causing an intensification in psychosocial distress.”

I have previously posted on the link between depression and heart problems and how standard care for cardiac patients fails to take into consideration the psychosocial needs. It has also been shown that a stable life partnership helps in patient recovery.

In the US, the standard care for myocardial ischemia is medication and revascularization procedures. In Europe, on the other hand, treatments include aside from pharmacotherapy, cognitive-behavioral therapy and rehabilitation programs similar to those used for chronic pain.

D. Sullivan concludes:

“Physicians need to assess patients with frequent angina for anxiety and depression. It’s not all ischemia. There are other very important aspects to angina that can be diagnosed and treated either with psychotherapy or medication. Reducing anxiety and depression may be a cost-effective way to reduce angina.”

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