Psychopharmacologic Management of Anxiety in the Cardiac Patient

Abstract

Of 253 patients who had suffered acute myocardial infarction (MI), 88 percent received daytime sedation while hospitalized. Sixty percent of all prescriptions were for phenobarbital, 30 percent for chlordiazepoxide, and 6 percent for meprobamate. In addition, 79 percent of patients received night time hypnotic medication. Sixty-six percent of such prescriptions were for short-acting barbiturates, 21 percent for chloral hydrate, and 7 percent for diphenhydramine. Multiple drug use was common.

The barbiturates, while inexpensive sedative agents, are of questionable efficacy in reducing anxiety and probably produce only general CNS depression. A narrow margin of safety, liability to produce habituation, and antagonism of warfarin-type anticoagulants are other disadvantages. The benzodiazepine tranquilizers, whose antianxiety efficacy is more clearly established, do not produce general CNS depression, have a wide margin of safety, and do not interact with oral anticoagulants.

Antidepressant agents, phenothiazine tranquilizers, and propranolol were used infrequently or not at all. The risks associated with the use of these agents in patients with acute myocardial infarction are considerable and should be weighed carefully before they are administered.