Depression with Panic Episodes and Coronary Vasospasm

Abstract

Variant (Prinzmetal's) angina is an uncommon cause of precordial pain caused by coronary vasospasm and characterized by transient ST elevation and negative markers of myocardial necrosis. This is the case of a female patient with a prior history of depression and panic attacks who presented with recurrent symptoms including chest pain. A cardiac event monitor positively documented coronary vasospasm associated with anxiety-provoking chest pain, whereas the coronary arteries were angiographically normal. We noted that the frequency of angina attacks apparently increased during the period that coincided with the introduction of Bupropion SR for treatment of the patient's depression. Considering the possibility of bupropion-associated negative impact on coronary vasospasm, the antidepressant therapy was adjusted to exclude this drug. Although Prinzmetal's angina is relatively uncommon, we suspect that a routine use of cardiac event monitors in subjects with panic disorder might reveal a greater incidence of coronary vasospasm in this patient population.

Bupropion and Panic Disorder: Case Report and Review of the Literature

“…de Graaf and Diemont 18 have suggested that treatment with bupropion may be associated with chest pain, presumably exerting a direct action on the human myocardium by triggering catecholamine release. 19 According with this evidence, Vidovich et al 20 recently reported that bupropion presumably exacerbated a recent angina episode through coronary vasospasm in a patient suffering with depression, panic episodes, and recurrent coronary vasospasm, so bupropion treatment required a reduction of dosage in patients with cardiovascular disease. A further consideration must be relative to cognitive impairment, which was clinically observed with bupropion treatment at increased dosages.…”

Bupropion and Panic Disorder: Case Report and Review of the Literature

“…However, previous evidence reported negative findings (e.g., increased panic and anxiety symptoms) with combined pharmacological strategies of the SSRI fluoxetine and bupropion, 15 and a related lack of efficacy in the treatment of panic disorder with phobias. 19 According with this evidence, Vidovich et al 20 recently reported that bupropion presumably exacerbated a recent angina episode through coronary vasospasm in a patient suffering with depression, panic episodes, and recurrent coronary vasospasm, so bupropion treatment required a reduction of dosage in patients with cardiovascular disease. When his dosage was increased to 300 mg daily, our patient experienced strong adverse effects; in particular, he was very fearful about the onset of chest pain.…”