Bridging Minds and Hearts by Exploring the Comorbidities Between Anxiety, Depression, and Takotsubo Cardiomyopathy: A Scoping Review.

Background/

Objectives

Takotsubo cardiomyopathy (TTC), also known as "broken heart syndrome", is an acute and reversible cardiac condition often triggered by emotional or physical stress. Increasing evidence suggests a strong comorbidity between TTC and psychiatric disorders, particularly anxiety and depression. However, the nature, prevalence, and implications of these associations remain incompletely understood. This scoping review aimed to systematically map the available evidence on the association between Takotsubo cardiomyopathy and anxiety and depressive disorders, characterize the prevalence and nature of these psychiatric comorbidities, evaluate the methods used for their assessment, and identify knowledge gaps to guide future research and clinical practice.

Methods

A systematic search of MEDLINE (via PubMed), Embase, Web of Science, and Google Scholar was conducted for peer-reviewed human studies published up to December 2025 in English or French. Eligible studies reported on psychiatric comorbidities in TTC populations, including pre-existing disorders, psychiatric triggers, or psychological sequelae. A standardized extraction grid and the Joanna Briggs Institute appraisal tools were used for data collection and quality assessment.

Results

Eighteen studies were included. Depression and anxiety were prevalent among TTC patients, frequently preceding or accompanying cardiac events. Emotional stressors such as bereavement or panic attacks were commonly cited as triggers. Despite this, only a minority of studies used validated psychometric tools, and longitudinal psychiatric follow-up was rare. Most studies were limited by small sample sizes, retrospective designs, and heterogeneity in diagnostic approaches.

Conclusions

The findings reveal a consistent association between TTC and affective disorders, underscoring the role of the brain-heart axis. Integrating psychiatric screening and follow-up into TTC management may enhance outcomes. Future interdisciplinary research is needed to clarify causal pathways and inform prevention and treatment strategies.