Anxiety and heart issues: How to safely medicate for both

Jan 15, 2024

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.

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:

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:

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

A doctor may recommend the following dosages:

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.

Possible side effects of benzodiazepines include:

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

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

People may take antidepressants in various forms, including:

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

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.

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

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.

Click here for more links and local resources.

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

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.