How to Treat Cardiac Neurosis: Effective Medications and Management Strategies

Cardiac neurosis, also known as cardiovascular neurosis or functional heart disorder, is a condition often rooted in psychological factors such as anxiety, stress, and emotional imbalance. While patients may experience real and distressing physical symptoms—such as palpitations, chest discomfort, shortness of breath, and fatigue—the underlying cause is typically not structural heart disease. Instead, it stems from dysfunction in the autonomic nervous system influenced by mental health. Therefore, an effective treatment plan should involve collaboration with specialists in medical psychology and psychiatry.

First-Line Treatment: Addressing Anxiety and Mood Disorders

Antidepressants and anxiolytics play a central role in managing cardiac neurosis, particularly selective serotonin reuptake inhibitors (SSRIs), which are considered first-line pharmacological treatments. Medications like citalopram, paroxetine, and fluvoxamine help regulate mood, reduce anxiety, and improve overall emotional resilience. Another commonly prescribed option is melitracen, often combined with fluphenazine in low doses, which has shown effectiveness in alleviating both depressive and somatic symptoms associated with this condition.

In cases where acute anxiety or insomnia is present, short-term use of mild sedatives such as diazepam or eszopiclone can be beneficial. These medications help calm the nervous system and promote restful sleep, which is essential for recovery. However, they should only be used under strict medical supervision and for limited durations to prevent dependency.

Managing Physical Symptoms: Targeting Heart Rate and Autonomic Overactivity

Controlling Tachycardia with Beta-Blockers

Many individuals with cardiac neurosis experience heightened cardiovascular activity, including persistent tachycardia (elevated heart rate). In such cases, low-dose beta-blockers like metoprolol can be effective in reducing heart rate and minimizing palpitations. However, because metoprolol is lipophilic, it can cross the blood-brain barrier and potentially cause side effects such as dizziness or worsened insomnia.

For patients who are prone to sleep disturbances, non-lipid-soluble beta-blockers such as atenolol may be a better alternative. These agents primarily act on peripheral receptors without significantly affecting the central nervous system, making them safer for long-term use in anxious patients with sleep concerns.

Addressing Common Comorbidities: Digestive Health Support

Chronic stress and autonomic imbalance often lead to gastrointestinal issues in people with cardiac neurosis. Symptoms such as bloating, indigestion, and discomfort after eating are common due to disrupted gut motility and enzyme secretion. To support digestive function, physicians may recommend medications like pancreatin or azymuth (containing pancreatin and bile components), which aid in food digestion and alleviate upper abdominal discomfort.

Integrating dietary adjustments—such as eating smaller, more frequent meals, avoiding stimulants like caffeine, and reducing processed foods—can further enhance gastrointestinal well-being and contribute to overall symptom relief.

The Importance of Long-Term Management and Gradual Discontinuation

One of the key aspects of successful treatment is continuity. Even when significant improvement occurs, stopping medication abruptly increases the risk of relapse and may reinforce negative beliefs about recovery. Experts recommend maintaining therapy for at least three to four months after symptom stabilization.

After this period, any discontinuation should be done gradually through a step-down approach, slowly tapering dosages under professional guidance. This helps prevent withdrawal-like reactions—sometimes referred to as "discontinuation syndrome"—which can mimic a return of symptoms and undermine patient confidence.

Crucial Reminder: Always Seek Professional Medical Guidance

All medications discussed—from SSRIs and benzodiazepines to beta-blockers and digestive enzymes—should only be taken under the supervision of a qualified healthcare provider. Self-medication can lead to adverse effects, drug interactions, or misinterpretation of symptoms. A personalized treatment plan that combines medication, cognitive-behavioral therapy (CBT), lifestyle modifications, and stress management techniques offers the best outcome for long-term recovery.

With proper care, most individuals with cardiac neurosis experience substantial improvement and can regain full control over their physical and emotional well-being.