Depression and anxiety in patients receiving an implantable cardioverter defibrillator with or without cardiac resynchronization therapy

Implantable cardioverter defibrillators (ICDs) represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients, while ICDs with cardiac resynchronization therapy defibrillators improve morbidity, quality of life, and mortality in eligible patients with heart failure who are on optimal medical therapy. However, these devices may adversely affect the patients' psychological status after the delivery of shock therapies or even because of the fear of impending therapy. On the other hand, the potential of effective treatment of malignant arrhythmias may provide a 'safety' sensation in most treated patients without significant impairment in the quality of life during periods of clinical stability. During the past few years, an increasing number of reports have investigated psychological distress, including depression and anxiety status in ICD/cardiac resynchronization therapy defibrillator recipients. However, heterogeneous results have been reported while data on the variation of these psychological indexes over time in implanted patients are quite limited. Several intrinsic and extrinsic factors affect the psychological status of these patients while variations of these disturbances in specific populations are evident. Factors that seem to be associated with a greater risk for depression and anxiety in this setting include female gender, younger age, and device shock therapies. Moreover, depression and anxiety may have an adverse impact on patients' clinical outcomes exacerbating heart failure and increasing the arrhythmic risk. In this brief review article, we provide a concise and critical overview of the current literature on this topic, and we also discuss unresolved and conflicting issues delineating future perspectives.