Bidirectional relationship
There is a complex relationship between depression, anxiety, and AFIB. AFIB can cause depression and anxiety in patients. Depression and anxiety may create an environment that is conducive for the initiation and perpetuation of AFIB.
Depression and anxiety affect how patients perceive their illness, and impact healthcare utilization. The presence of depression and anxiety can impact the effectiveness of certain AF treatments.
Patients with AF reported significant declines in satisfaction related to work, sex life, household activities, social life, and leisure time due to disease-related limitations.
Anxiety
There is a bidirectional relationship between AFIB and anxiety.
38% of the patients with AFIB show high rates of anxiety. This is higher than the rate of anxiety in patients with hypertension (22%).
Anxiety may contribute to AFIB by:
- Increased inflammation and oxidative stress.
- Increased catecholamines (adrenaline).
- Hyperactive renin-angiotensin-aldosterone axis which may lead to fibrosis (scarring) of atrium.
AFIB contributes to anxiety due to unpredictable nature of its symptoms. The paradox of AFIB I have seen in my clinical practice is that the more AFIB the patient has, the less anxious they are about it.
High levels of anxiety may make treatment of AFIB more difficult and less likely to be successful.
Depression
There is a higher rate of depression in patients with AFIB than in the general population.
The mortality risk was almost one third higher among men with AFIB and suffering depression compared to men without depression.
Patients with persistent atrial fibrillation tend to be more depressed than patients with paroxysmal atrial fibrillation. (Anxiety follows the opposite course in my experience.)
Gehi et. al found that patients were more likely to score higher on the Toronto Atrial Fibrillation Severity Scale (AFSS) in the presence of either depression or anxiety irrespective of arrhythmia burden.
Psychological stress was the most common factor triggering AFIB.
How does treatment of AFIB affect depression/anxiety
Cardioversion improves quality of life in patients with AFIB.
QoL was improved significantly 3 months after ablation in all patients (regardless of ablation success or AF type) and stayed significantly improved after a median of 4.3±0.5 years.
Conclusion
AFIB has a complex bidirectional relationship with anxiety and depression. Treatment of these disorders with non-pharmacological interventions may be helpful in managing AFIB.