Anxiety and heart issues may occur together due to the impact anxiety can have on the body. Certain lifestyle factors may increase the risk of heart issues, and chronic health conditions may also increase the risk of anxiety disorders.

The link between the two conditions may mean people require treatment for both anxiety and heart issues. They may require medication that is suitable for both conditions.

In this article, we explore how and why these two conditions may occur alongside one another and medications a doctor may prescribe.

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According to a 2021 report focusing on the United States and Canada, coronary artery disease (CAD) is the most common type of cardiovascular disease (CVD).

In people with CAD, heightened anxiety may increase the risk of serious cardiac events and may worsen the outlook for CAD.

The same report states that generalized anxiety disorder (GAD) and panic disorder are up to 15 times higher in people with CAD than in those without.

Researchers are still unclear about the link between anxiety and CAD, but possible links include:

  • increased inflammation
  • the link between anxiety disorders and increased rates of high blood pressure, diabetes, and obesity, which can all increase the risk of CVD
  • panic disorder and GAD, which may lead to poor health behaviors, such as increased risk of alcohol use disorder, smoking, or lack of physical activity, which can all increase CVD risk
  • high anxiety levels, which may reduce the likelihood of a person attending cardiac rehabilitation programs or taking heart medications
  • getting a chronic health diagnosis such as CAD

According to a 2018 article, there is a significant link between anxiety disorders and CVD in adults in the U.S.

In people with stable CAD, anxiety may increase the risk of serious cardiac events, including heart attack, cardiac arrest, and cardiac death.

There are several anxiety medications doctors may safely prescribe for people with heart issues. These include:

Benzodiazepines

Examples of benzodiazepines include:

Benzodiazepines may be a suitable first-line treatment for people with anxiety and CVD.

They may help treat myocardial ischemia, angina, high blood pressure, and congestive heart failure, particularly in people who also have anxiety.

They may also help lower high blood pressure and have fewer side effects than antidepressants for treating anxiety in people with CVD.

Benzodiazepines increase a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). This provides a calming or sedative effect.

Dosage

Dosage will depend on the type of benzodiazepine people are taking and a doctor’s recommendation.

A doctor may recommend the following dosages:

  • Alprazolam (Xanax): 0.25–1 milligram (mg) three times per day, up to a maximum of 4 mg per day.
  • Clonazepam (Klonopin): 0.5–1 mg three times per day, up to a maximum of 4 mg per day for anxiety.
  • Diazepam (Valium): 5–25 mg, three or four times per day, up to a maximum of 40 mg per day.

People can take benzodiazepines orally as a pill or tablet, which may come in different colors or shapes. It is also possible to inject benzodiazepines, though doctors typically only do this in special circumstances.

Side effects

Possible side effects of benzodiazepines include:

  • depression
  • confusion, impaired thinking, and memory loss
  • mood changes, such as feeling isolated or euphoric
  • headache
  • feeling drowsy, sleepy, or fatigued
  • dry mouth
  • changes to speech, such as slurring or stuttering
  • changes to vision, such as blurred or double vision
  • impaired coordination
  • dizziness
  • tremors
  • nausea
  • loss of appetite
  • diarrhea or constipation

Risks

According to a 2020 study from the Journal of the American Heart Association, benzodiazepines may have a higher risk of rehospitalization in people with heart failure and insomnia compared to treatment with nonbenzodiazepines.

Other risks of benzodiazepines include overdose, and the drugs may cause addiction and withdrawal symptoms.

Antidepressants

Antidepressants may be suitable for treating anxiety in people with CVD. Types of antidepressants include:

How they work

Antidepressants increase serotonin and norepinephrine, which are neurotransmitters in the brain. This helps alter mood and may help to treat anxiety disorders.

Research suggests there is no difference in CVD risk and the type of antidepressant people take. A 2019 article found that among people at risk of atherosclerosis, there was no difference in CVD risk in those using SSRIs and non-SSRIs.

Escitalopram (Lexapro) is an SSRI. In a 12-week study, escitalopram was safe and effective in reducing anxiety compared to a placebo in people with anxiety and stable coronary heart disease.

Dosage

Dosage will depend on the type of antidepressant people are taking. Examples of dosages include:

  • Escitalopram (Lexapro): Starting dose of 5–10 mg per day, which may increase to 10–20 mg per day.
  • Fluoxetine (Prozac): Starting dose of 20 mg per day, which may increase up to 60 mg per day.
  • Duloxetine (Cymbalta): Starting dose of 30 mg per day, which may increase up to 120 mg per day.

Available forms

People may take antidepressants in various forms, including:

  • oral tablets
  • liquid solution
  • skin patches

Side effects

Side effects can vary depending on the type of antidepressant people take but may include:

  • sexual dysfunction
  • feeling drowsy
  • weight gain
  • insomnia
  • dizziness
  • tremor
  • headache
  • blurred vision
  • dry mouth
  • nausea
  • rash

Risks

Antidepressants come with a black box warning as they may increase the risk of suicidal thoughts or behavior, particularly in young people.

Healthcare professionals will monitor people taking antidepressants for symptoms that may indicate worsening mental health conditions.

If people experience suicidal thoughts or behaviors, they should contact a healthcare professional straight away.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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The Centers for Disease Control and Prevention (CDC) recommend the following for managing anxiety or other mental health conditions alongside heart disease:

  • learning the signs of anxiety and heart disease so that people can recognize either condition
  • talking with a healthcare professional about the possible risks of heart conditions in relation to anxiety and steps to manage the risks
  • understanding that family history or genetics may play a part in risk for heart conditions
  • learning which health conditions increase the risk of heart disease, such as high blood pressure, and taking steps to manage them
  • maintaining a healthy lifestyle, such as increasing physical activity, maintaining a moderate weight, and eating a balanced diet
  • avoiding or quitting smoking, if applicable
  • learning coping strategies to manage stress

Medications such as benzodiazepines or antidepressants may help to reduce anxiety.

In most cases, research suggests these medications are safe for people with heart disease.

Heart disease and anxiety may link through physical changes to the body, such as inflammation and lifestyle behaviors, as well as mental health changes in response to a chronic health condition.

Medications to treat anxiety may be a safe and effective treatment option for people with CVD and anxiety.

People will need to discuss any medications and possible side effects with a doctor.