Researchers at Duke Medicine have revealed that a commonly prescribed antidepressant – escitalopram (Lexapro) – could be used to treat a heart condition caused by stress among people suffering from stable coronary heart disease.
The findings of the study, published in the May 22/29, 2013 issue of the Journal of the American Medical Association, found that people with stable coronary heart disease and mental stress-induced myocardial ischemia (MSIMI) taking escitalopram – a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety – experienced lower rates of MSIMI.
An Article published Online First and of The Lancet revealed that sertraline and escitalopram have clear advantages in terms of efficacy and acceptability among all SSRIs.
In MSIMI there is limited blood flow to the heart; it has been shown in previous studies that emotional stress can trigger heart conditions. This is of particular concern because patients with MSIMI tend to experience worse heart problems.
Lead author, Wei Jiang, M.D., associate professor of psychiatry and behavioral sciences and internal medicine at Duke, said:
“Mental stress-induced myocardial ischemia is a serious condition, as patients with the condition tend to have worse heart problems compared to patients without it. This study showed for the first time that it is treatable with an emotion-modulating medication.”
MSIM occurs as a result of changes in the heart, such as a reduction in the amount of blood pumped out of the heart’s left ventricle and problems with new wall motion.
There aren’t many options currently available to treat the condition.
Senior author, Christopher O’Connor, M.D., director of the Duke Heart Center and chief of the Division of Cardiology, said: “In order to advance our understanding of improving cardiovascular health, we believe that continued research between the intersection of mental health and cardiovascular disease should be a priority.”
In their “Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment” (REMIT) study, researchers evaluated possible ways to alleviate cardiovascular symptoms caused by mental stress.
A total of 310 people participated in the randomized, double blind, placebo controlled clinical trial.
The patients enrolled had pre-existing coronary heart disease. The researchers analyzed which participants experienced MSIMI by conducting a simple exercise stress test using a treadmill and three mental stress tests.
Heart function was assessed with echocardiography and electrocardiography.
127 of the patients who were tested had MSIMI – 112 of them completed the study. They were randomly selected to either receive escitalopram or placebo.
The team found that compared to placebo, those who were on escitalopram were 2.62 times less likely to experience MSIMI during the three mental stress tasks.
Participants in the escitalopram group felt more in control and calmer than those in the placebo group during the last mental stress task.
Jiang added: “Our findings support the hypothesis that short-term use of SSRIs improves levels of biomarkers associated with adverse cardiovascular outcomes.”
SSRIs could play an important role in managing coronary heart disease.
Study author Eric Velazquez, M.D., associate professor of cardiology at Duke, wrote:
“All physicians treating patients with coronary artery disease need to be aware of how emotional stressors may negatively impact their disease management. We should be having conversations with our patients about their lifestyles to gauge their levels of mental stress and whether the coping mechanisms they use are adequate or if more mental health-focused help is needed.”
The authors concluded:
“In summary, 6-week pharmacologic enhancement of serotonergic function superimposed on the best evidence-based management of CHD appeared to significantly improve MSIMI occurrence. These results support and extend previous findings suggesting that modifying central and peripheral serotonergic function could improve CHD symptoms and may have implications for understanding the pathways by which negative emotions affect cardiovascular prognosis.”
Further research is necessary to determine how long long escitalopram should be taken.
Stress can have a significant impact on heart problems. According to a study in The Lancet conducted by researchers from University College London, if you have a very stressful job and are not given the freedom to make decisions, your chances of experiencing a heart attack are 23% higher.
In addition, a 2008 study carried out by researchers at the same university in London involving over 10,000 civil servants also linked job stress to a higher risk of heart disease.
Written by Joseph Nordqvist