Renério Fráguas
Grupo de Interconsultas do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPq-HC-FMUSP), Departamento de Psiquiatria da FMUSP
Moacyr Roberto Cuce Nobre
Unidade de Epidemiologia Clínica do Instituto do Coração (InCor) do HC-FMUSP
Mauricio Wajngarten
Unidade Clínica de Cardiogeriatria do InCor-HC-FMUSP
Marcus Vinicius Cardeal
Grupo de Interconsultas do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPq-HC-FMUSP), Departamento de Psiquiatria da FMUSP
João Augusto Bertuol Figueiró
Centro de Dor do HC-FMUSP
Dan V. Iosifescu
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard University, Boston, USA.
Manoel Jacobsen Teixeira
Professor titular da disciplina de Neurocirurgia do Departamento de Neurologia da FMUSP
Abstract:
Objective: To investigate the presence of psychiatric disorders in patients with chest pain not responsive to treatment. Method: We evaluated 18 patients judged by their physicians to have a chest pain not responsive to usual treatment, which included anti-pain medicines and investigation and treatment of possible etiological causes such as coronary artery disease, and gastroesophageal reflux disease. A psychiatrist interviewed the patients using the Present State Examination and made the diagnosis based on the DSM-III-R criteria. Current major depression was diagnosed in 6 (30%) patients, somatization in 1 (6%) and panic disorder in 1 (6%) patient. Seven patients were receiving tricyclics antidepressant with doses ≥ 75 mg/day. Discussion: Patients were receiving doses of tricyclics antidepressants efficacious for pain but not for major depression. It is possible that the low dose of antidepressants used to treat pain may partially ameliorate depressive symptoms, making the appropriate diagnosis and treatment of major depression even more difficult, consequently contributing to the persistence of pain and other complains. Considering the wide alternatives to effectively treat depression, a focus on detection and treatment of major depression in patients with chest pain is warranted by clinicians and researchers.
Keywords:Depression, cardiology, pain, treatment, primary care.