Heart Disease: Anger, Depression, and Anxiety

Mark W. Ketterer

It has long been assumed that the emotional distress (depression/anxiety/irritability) commonly observed in coronary heart disease (CHD) patients is a “natural” reaction to the diagnosis. This is an erroneous, harmful, and expensive assumption. It is now clear that, for large numbers of patients, emotional distress predates and predicts the onset of CHD. For those who do not have premorbid emotional distress, reactive depression/anxiety (and anger) will still adversely affect the progression of atherosclerosis, ischemic episodes, myocardial infarction (MI)/death, noncompliance, symptoms, and utilization. Major depression occurs in 18% to 20% of CHD patients (a fivefold increase over general population levels), and “minor” depression (dysthymia or adjustment disorder with depressed mood) occurs in another 10% to 15% (also a fivefold increase over general population levels). The distinction between major (per DSM-IV criteria) and minor depression (Beck scores of 10 or greater) has not been found to be useful in terms of Noncardiac ...

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