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Cardiac symptoms and anxiety disorders: contributing factors and pharmacologic treatment
1Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Anxiety negatively impacts cardiovascular health. While treatments like benzodiazepines can help, subjective symptom improvement doesn't always mean better heart health, necessitating objective measures for medication assessment.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Anxiety poses risks to the cardiovascular system, especially in individuals with existing or predisposed cardiovascular disease.
- Factors influencing anxiety's cardiovascular impact include anxiety type, constitutional traits, and personality.
- Anxiety treatment can benefit cardiovascular patients, but symptom relief doesn't always equate to cardiovascular improvement.
Purpose of the Study:
- To evaluate the differential effects of anxiety medications on the cardiovascular system.
- To highlight the importance of objective measures in assessing anxiety treatment efficacy for cardiovascular patients.
Main Methods:
- Review of existing literature on anxiety, cardiovascular disease, and psychotropic medications.
- Analysis of the distinct mechanisms of action for antidepressants, beta-blockers, and benzodiazepines on psychic anxiety and sympathetic tone.
- Discussion on the correlation between subjective symptom reporting and objective physiologic changes.
Main Results:
- Antidepressants may worsen cardiovascular parameters despite reducing psychic anxiety.
- Beta-adrenergic blockers reduce sympathetic tone but do not alleviate psychic anxiety.
- Benzodiazepines are effective in reducing both psychic anxiety and sympathetic tone.
Conclusions:
- Benzodiazepines demonstrate a dual benefit for anxiety and cardiovascular health.
- Subjective reports of symptom improvement are unreliable indicators of cardiovascular benefit.
- Objective physiologic assessments are crucial for evaluating anxiety medications in cardiovascular populations.
Abstract:
Anxiety may have deleterious effects on the cardiovascular system in persons who have, or are predisposed to have, cardiovascular disease. Contributing factors consist of the type of anxiety, constitutional characteristics and personality traits. The treatment of anxiety thus has a beneficial effect on patients with cardiovascular disease. However, anxiety reduction through medication, even if it includes subjective improvement in somatic symptoms, should not necessarily be equated with beneficial effects on the cardiovascular system. Three groups of medication used in the treatment of anxiety have different effects. Antidepressants lower psychic anxiety but may have the opposite effect on the cardiovascular system, whereas beta-adrenergic blockers lower sympathetic tone without affecting psychic anxiety. Only benzodiazepines fulfill both functions. Since subjective reports of somatic, including cardiovascular, changes correlate poorly with physiologic changes, assessment of new medications should not rely on self-reported improvement in cardiac symptoms but should include objective measures as well.