Key Points
- To raise awareness of severe anxiety and depression occurring in patients who receive electrical shocks from implanted cardioverter-defibrillators (ICDs).
- Monitored 35 patients with ICDs implanted for refractory ventricular tachyarrhythmias at a single hospital clinic over a six-year period.
- Identified patients who developed overt psychopathology after device shocks and referred them to a designated psychiatrist for assessment and intervention over a median follow-up of 27.5 months (range 8–43 months).
- Six of 35 patients (17%) developed florid psychiatric disorders after receiving appropriate shocks (ranging from 2 shocks in six months to 111 shocks in 24 hours), despite having no premorbid psychiatric history.
- All six patients exhibited severe anxiety centered on the fear of subsequent shocks, three experienced major depression, and two became housebound.
- All affected patients improved within weeks following treatment with anxiolytic or antidepressant medications combined with relaxation and cognitive behavioral therapies.
Structured PICO
PPopulation35 patients with implanted cardioverter-defibrillators (ICDs) for serious ventricular tachyarrhythmias inadequately controlled by drug treatment and unsuitable for map guided antiarrhythmic surgery.
IInterventionImplanted cardioverter-defibrillator (ICD) shocks
OOutcomeDevelopment of overt psychopathology (severe anxiety or depression)safety
Patients receiving ICD shocks are at high risk for developing severe, disabling anxiety and depression, highlighting the need for psychological support and psychiatric management.