People with pulmonary arterial hypertension (PAH) display higher levels of depression and anxiety than previously estimated by healthcare workers, according to a study published in Vascular Health and Risk Management. There is also little consensus about how to treat these mental disorders in this comorbidity, underscoring the need for further research.
This literature review included 3 studies on the prevalence of depression and anxiety in people with PAH and 8 studies on the clinical relevance of psychological symptoms. Cochrane Library, Medline, and PsychINFO (2004 to 2018) were used to compile these studies. Psychological interventions, the slow breathing approach, and the chosen pharmacological regimen were among the primary points of interest.
Depression affects between 7.5% and 53.0% of those with PAH, while panic and anxiety disorders affect between 19.0% and 51.0%. Depression is significantly higher in patients with pulmonary arterial hypertension than in the general population (25.0% vs 6.7%, respectively). The long latent period before disease manifestation likely contributes to these mental conditions.
Psychological treatment is officially recommended by the European Society of Cardiology, although currently, evidence for specific psychological intervention is unavailable. However, there is support for slow breathing, relaxation, and cognitive behavioral therapy based on treatment performed in other chronic illnesses. The efficacy of antidepressant drugs is unclear, and there has been a noncausal correlation between antidepressant use and higher risk for PAH.
The study researchers concluded that “[f]irstly, our data demonstrate a common underestimation of mental disorders by health professionals and secondly, the need of implementing appropriate methods of screening for mental disorders in PAH patients. However, the paucity of large observational studies in this area requires the attention of researchers.”
Bussotti M, Sommaruga M. Anxiety and depression in patients with pulmonary hypertension: impact and management challenges. Vasc Health Risk Manag. 2018;14:349-360.