Anxiety and depression in patients with pulmonary hypertension: impact and management challenges

Abstract

BackgroundAnxiety and depression are frequent disorders in patients with pulmonary arterial hypertension (PAH), but despite this only less than one-fourth of them is treated. Our aim was to review the studies regarding the prevalence and the impact of anxiety and depression and to propose management challenges.MethodsA literature review regarding 1) anxiety and depression studies in PAH patients and caregivers, 2) psychological interventions, 3) slow breathing approach, and 4) pharmacological approach was performed, based on evidence of effectiveness through a search of the most well-known databases (Cochrane Library, Medline, PsychINFO [2004–2018]).ResultsThe prevalence of mental disorders in PAH patients lies between 7.5% and 53% for depression and 19% and 51% for anxiety and panic disorders. The latest guidelines of the European Society of Cardiology recommend a psychological support with a class of recommendation I and a level of evidence c. The analysis of psychological intervention shows that at present there is no evidence of specific psychological interventions in these patients. However, treatment approaches based on other chronic illnesses are suggested, especially based on relaxation training, slow breathing, and cognitive behavioral therapy. Finally, data concerning the use of antidepressant drugs are conflicting.ConclusionFirstly, 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. The evidence about optimal approaches for managing anxiety and depression in PAH also remains unclear and largely speculative. The challenge is the introduction of routine psychological intervention, as suggested by the European Society of Cardiology and already applied in other chronic disease.

My life with pulmonary arterial hypertension: a patient perspective

“…Finally, HCPs should consider the psychological aspects of a chronic illness experienced by patients with PAH 29 . A high incidence of mental health conditions, such as anxiety and depression, has been reported in patients with PH, 30 , 31 with between 20% and 35% of patients with PAH in the REVEAL registry diagnosed with depression 32 . As anxiety and depression in patients with PAH are often associated with an impaired QoL, 33 HCPs should make sure to address these conditions as part of patients’ ongoing care.…”

Adults’ experiences of living with pulmonary hypertension: a thematic synthesis of qualitative studies

“…A range of psychological treatments have been shown to be effective for GAD, 44 however, there is paucity of evidence regarding psychological treatments in PH. 45 …”

PH Professional Network: Bridging the Gap: A Multidisciplinary Approach to Transitions of Care

“…17 Review of the PAH literature demonstrates depression rates of 7.5% to 53% and anxiety and panic disorder rates of 19% to 51%. 18 In fact, PH-specific patient-reported outcome tools have been increasingly used in various settings and may be incorporated into hospital discharge workflow, posthospitalization follow-up visits, routine outpatient appointments, and hospitalizations to guide education and treatment. Recent European Society of Cardiology recommendations include psychological support for PH patients as a class I recommendation.…”

“…Given a paucity of data on treatment approaches for depression in PH, methods used in other chronic illnesses have been suggested, including relaxation training, breathing techniques, and cognitive behavioral therapy. 18 Without question, mood disorders are underdiagnosed in PH, and the impact on overall morbidity and mortality are not understood.…”