Intended for healthcare professionals

Clinical Review

Treatment of anxiety and depressive disorders in patients with cardiovascular disease

BMJ 2004; 328 doi: (Published 15 April 2004) Cite this as: BMJ 2004;328:939
  1. Simon J C Davies (, clinical research fellow1,
  2. Peter R Jackson, consultant physician2,
  3. John Potokar, senior lecturer1,
  4. David J Nutt, professor1
  1. 1Psychopharmacology Unit, Dorothy Hodgkin Building, Bristol BS1 3NY
  2. 21Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Sheffield S10 2JF
  1. Correspondence to: S J C Davies

    What role do selective serotonin reuptake inhibitors have in treating psychiatric morbidity in patients with cardiovascular disease? This review discusses the safety and efficacy of various antidepressants in this group of patients and their potential for improving cardiovascular outcomes


    Anxiety and depressive disorders are common in the general population and are particularly prevalent in patients with cardiovascular disease (box 1).13 w1-w3 We reviewed evidence for a biological explanation for this association and for drug treatment and psychotherapy for psychiatric morbidity in patients with cardiovascular disease.

    Sources and selection criteria

    We systematically searched Medline (1966 to August 2003 through Ovid) and Embase (1980 to October 2002) for all relevant English language articles. Firstly, we entered terms and text words including myocardial infarction, angina, hypertension, stroke, cerebrovascular, and poststroke. Secondly, we used the terms and text words “SSRIs”, “serotonin reuptake inhibitors”, and individual drug names. The searches were combined and relevant articles retrieved. The reference lists were searched for other potentially relevant articles.

    Cardiovascular disease and psychiatric morbidity

    Much evidence links depression with coronary artery disease and hypertension; 16% of patients assessed seven days after myocardial infarction had symptoms consistent with a major depressive episode.1 w1 w2 Several studies have shown a link between anxiety disorders and coronary heart disease and between anxiety disorders and hypertension.2

    Associations between psychiatric morbidity and cardiovascular disease could simply be attributed to patients being psychologically undermined after diagnosis but this does not explain prospective studies showing excess incidence of cardiovascular problems or poorer cardiovascular outcome in patients with depression and anxiety disorders. One study reported a 3.5-fold increase in mortality of depressed patients compared with non-depressed patients within six months of myocardial infarction.1 Depression has been associated with the development of cardiovascular complications in patients with hypertension, and several prospective studies have suggested a link between anxiety disorders and …

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