Q. How is anxiety and depression related to cardiovascular diseases?
Ans. Any long standing medical conditions like arthritis, GI disorders, cardiovascular diseases can lead to anxiety and depression. Similarly, anxiety and depression may also precipitate any of the above medical conditions. The psychological stress due to anxiety and depression along with these medical conditions are known as psychosomatic or psychophysiological disorders.
Q. What are the criteria for diagnosis of depression with cardiovascular diseases?
Ans. The criteria for diagnosis of anxiety and depression associated with cardiovascular diseases are :
Any existing cardiovascular disease such as ischaemic heart diseases (angina or myocardial infarction),hypertension, cardiac arrhythmia etc leading to anxiety and depression
OR
Psychological factors (e.g. anxiety and depression) leading to cardiovascular disorders.
The patient in these conditions may present symptoms of anxiety and depression such as :
- Insomnia-usually waking in the morning at least two hours before the usual time.
Inner feelings of tension, apprehension (anxiety mood)
- Disturbance of intellectual capacity
- Loss of interest and enjoyment
- Reduced energy, which in turn causes tiredness and reduced activity
- Reduced attention and concentration
- Ideas of guilt, worthlessness
- Lowered self esteem
- Somatic and autonomic symptoms including tension, headache, backache, perspiration, dizziness, palpitation, breathlessness, gastrointestinal distress etc.
along with symptoms of cardiovascular diseases such as chest pain, angina, increased blood pressure, difficulty in breathing, arrhythmia and myocardial infarction.
Q. What are the mechanisms of depression induced cardiovascular diseases?
Ans. Anxiety and depression along with stress has been shown to cause
- Increased atherogenesis (increased fatty deposits in blood vessels)
- Decrease in stress induced endothelium mediated vasodilator response and paradoxical vasoconstriction
- Increased platelet aggregation
leading to either ischaemic heart disease/atherosclerosis, cardiac arrhythmia, congested cardiac failure etc.
Q. How can anxiety and depression affect the course of cardiovascular diseases?
Ans. Cardiovascular system is commonly attacked by anxiety and depression thereby affecting it's course. Anxiety attacks can increase the heart rate and blood pressure. Both anxiety and depression may give rise to chest pain and certain other factors that can affect the course of cardiovascular diseases :
(a) Anxiety and depression can lead to change in lifestyles which can affect cardiovascular systems
- Smoking-people smoke more in depression
- Serum cholesterol-these levels increase because of lipid release from deposits during stress produced as a result of depression
- Hypertension-well known fluctuation because of sudden autonomic activity
- Obesity-people do not reduce weight because of decreased will to exercise or do any from of physical activity.
(b) Anxiety and depression can also influence cardiovascular diseases in the following manner
- Myocardial infarction : incidence and mortality is increased if inadequate or improper treatment of depression occurs
- Ischaemic heart disease : mortality when associated with anxiety and depression is four times higher than general population
- Non exertional chest pain - directly related to psychological factors
- Congestive cardiac failure precipitated anxiety.
(c) It is generally seen that patients suffering from anxiety and depression show inadequate response to therapy :
- There is poor recovery inspite of appropriate medication
- Recurrent episodes of hospital stay due to anxiety
- Adjustment disorders-poor compliance of attitude towards treatment.
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