Anxiety is common amid patients with coronary heart disease (CHD) and is related with inferior health outcomes; however, effective treatment for anxiety in patients with CHD is undefined.

A randomized clinical trial was carried out to know whether exercise and escitalopram are better than placebo in reducing symptoms of anxiety as measured by the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) and in improving CHD risk biomarkers.

Study participants had stable CHD and severity of anxiety symptoms graded at least 8 on the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) or a primary diagnosis of an anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).  Individuals who were currently receiving mental health treatment and those who exercised at least 1 day per week were excluded.

Participants in the exercise group and the escitalopram group reported greater mean reductions in HADS-A scores. HADS-A scores for the escitalopram group were lower compared with the exercise group (-1.67; P =.002).

Significant postintervention group differences in 24-hour urinary catecholamines were found, with better reductions reported in the exercise group and escitalopram group compared with the placebo, and greater decreases in the escitalopram group compared with the exercise group.

All groups achieved comparable but small changes in CHD biomarkers, with no differences between treatment groups.

Treatment of anxiety with escitalopram was safe and effective for reducing anxiety in patients with CHD. Though, the beneficial effects of exercise on anxiety symptoms were less consistent.

Source: JAMA Psychiatry. August 182021. doi:10.1001/jamapsychiatry.2021.2236