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Anti-Depressant Medication Reduces Mental Stress-Induced Cardiac Ischemia In Patients With Heart Disease

INTRO:Mental stress can induce episodes of myocardial ischemia, which can result from an imbalance of blood flow supply and demand to the heart. A new study examined whether patients with stable coronary heart disease who experience episodes of mental stress-induced myocardial ischemia could reduce the risk of these events by taking an anti-depressant medication. Catherine Dolf has more in this week’s JAMA Report.

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Glenn walking down hospital hallway

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WILLIAM GLENN SCALES SPENT HIS CAREER WORKING IN A HOSPITAL BUT WAS NEVER A PATIENT.

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SOT/FULL Super @:04 William Glenn Scales – Heart Patient Runs:12
“So at the age of 55 to finally suddenly find myself diagnosed with heart disease that required heart surgery was very, very traumatic.”

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Glenn with electrodes, monitor of heart pumping

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IN SOME PATIENTS WITH CORONARY DISEASE, MENTAL STRESS CAN INDUCE MYOCARDIAL ISCHEMIA, WHICH RESULTS FROM DECREASED BLOOD FLOW TO THE HEART.

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SOT/FULL Super @:23 Eric J. Velazquez, M.D., – Duke University Medical Center Runs:10
“We really set out to see if we could test whether a treatment focused on psychological well-being on emotional stressors might have an impact on minimizing that ischemia.”

(Video covering 2nd half of bite: Glenn undergoing stress test)

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SOT/FULL Super @:33 Wei Jiang, M.D., – Duke University Medical Center Runs:08
“We know very well that Escitalopram as well as other SSRI’s reduce depression as well as anxiety.”

(Video covering end of bite: medication bottles)

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Dr. Jiang walking outside, monitors, staff and patient in stress lab

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DOCTORS WEI JIANG (Zheng) AND ERIC VELAZQUEZ (Veh-laahs-kez) FROM DUKE UNIVERSITY MEDICAL CENTER AND CO-AUTHORS CONDUCTED A RANDOMIZED DOUBLE BLIND PLACEBO CONTROLLED TRIAL INVOLVING 127 PATIENTS WITH STABLE CORONARY HEART DISEASE.

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SOT/FULL Super @:52 Wei Jiang, M.D., – Duke University Medical Center Runs:08
“All 127 patients have had a mental stress induced myocardial ischemia at the time they were randomized.”

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Various shots of patient going thru various tests

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SEVERAL MENTAL STRESS TESTS WERE USED TO EVALUATE THESE PATIENTS, INCLUDING MENTAL ARITHMETIC, COUNTING BACKWARD FROM 400 SUBTRACTING 7 EACH TIME, AS FAST AS POSSIBLE.

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NATSO/FULL Runs:07
“…372…faster…365, 358…”

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Glenn tracing star on mirror

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ANOTHER, REQUIRED PATIENTS TO TRACE A STAR 30 TIMES IN THREE MINUTES ON A MIRROR.

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Runs:03    “…remember stay within the black line you are making too many mistakes…”

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Medication bottles

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PATIENTS WERE THEN RANDOMIZED TO RECEIVE ESCITALOPRAM (Eh-see-TAHL-ah-pram) OR PLACEBO FOR SIX WEEKS.

AUDIO Super @ 1:27 Wei Jiang, M.D., – Duke University Medical Center Runs:14
“About 34 percent of them at the end of the six week treatment did not have mental stress induced ischemia in the escitalopram group versus about 17 percent in the group taking placebo.”

(Video covering end of bite: Glenn being tested)

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JAMA COVER

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THE STUDY APPEARS IN JAMA, JOURNAL OF THE AMERICAN MEDICA ASSOCIATION.

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SOT/FULL Super @1:45 Eric J. Velazquez, M.D., – Duke University Medical Center Runs:12
“A medication that focuses on reducing emotional stress may be a mechanism to manage that ischemia which is not only important but which is not necessarily targeted by other therapies.”

(Video covering middle of bite: Glenn being tested)

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Glenn with staff person shaking hands and leaving

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GLENN, NOW RETIRED, SAYS HE’S LEARNED SOME IMPORTANT THINGS ABOUT TAKING CARE OF HIMSELF.

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SOT/FULL Super @ 2:02 William Glenn Scales – Study Participant Runs:07
“Get serious about exercise, pay attention to your diet and the most important thing is to listen to your body.”

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Shot of heart beating on monitor

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CATHERINE DOLF, THE JAMA REPORT.

TAG: RESEARCHERS SAY FURTHER STUDIES ARE NEEDED TO DETERMINE IF THIS MEDICATION MAY HAVE BENEFICIAL EFFECTS FOR PATIENTS WITH OTHER TYPES OF CARDIOVASCULAR DISEASE