I've been experiencing tight pressure and extreme pain in my chest, into my back and radiating up into my jaw. It seems to come when I'm sleeping or doing housework or at school. I'm under a lot of stress, but I also am 100 pounds overweight, a one-pack-a-day smoker, and suffer from depression (worse in the winter). I am taking Prozac daily. My doctor wants me to see a psychiatrist because I told him I thought it was panic attacks. My doctor said that he didn't think it was my heart because I'm only 36 and female. I don't want to wait and find out if this is leading to a major heart attack, as I have a husband and three children. What should I do? What tests should I request? Or is it all in my head? I'm very scared. --Jodi

I can't speak specifically about your situation, of course, without having conducted a thorough assessment. And since I'm a clinical psychologist (with a Ph.D. in psychology) and not a physician, I am not qualified to assess whether you are truly experiencing heart problems. It's very important that any such physical problems be diagnosed -- or ruled out -- by a qualified physician.

It's not clear from your question whether your physician has actually examined the functioning of your heart, whether by electrocardiogram (ECG), stress test, or other means. A thorough physical examination by him or her -- or another physician if you want a second opinion -- should be able to answer that part of your question.

That said, there are actions that anyone experiencing either cardiac problems OR anxiety and depression (or all of the above) can take that will help either condition. You probably already know that smoking is a no-no; it's bad for your arteries as well as your lungs. A smoking cessation program, sometimes available through your local hospital or the American Cancer Society, might be of help. I also know a woman who found acupuncture extremely helpful in stopping smoking and alleviating the associated anxiety. (Which reminds me that traditional Chinese medicine, in which acupuncture was developed, has long held that "sadness affects the heart" ... a precept that may have been supported by recent research finding an association between depression and hardening of the arteries.)

Although many medical professionals would consider your weight to be a risk factor, I wouldn't jump to that conclusion automatically. I think that in most cases the real culprit is inactivity (and sometimes eating habits) rather than weight itself. In my experience, focusing on weight as a problem can lead people to engage in unhealthy weight-control strategies, such as restrictive eating or dieting, which can often backfire and contribute to feelings of failure.

I recommend that people focus on increasing movement through enjoyable activities such as walking, dancing, gardening, yoga, tai chi, etc. The key is to find activities you enjoy. (If you don't like running, for instance, you probably won't keep it up.) The book "Great Shape: The First Fitness Guide for Large Women" by Pat Lyons and Debby Burgard is a great resource. I also like "Yoga for Round Bodies," a two-videotape set featuring a couple of very flexible large-size female yoga teachers for whom yoga increased strength and flexibility and helped manage stress. (The magazine Yoga Journal also has produced a good yoga video for the general public, called "Yoga Practice for Beginners.")

A psychologist or other licensed mental health professional trained in psychotherapy may also help you address your depression, stress, and anxiety and help you put in motion behavioral changes that can increase your physical as well as emotional health. If you see a psychiatrist as your physician recommended, make sure he or she uses psychotherapy as well as medication management. (Many psychiatrists are trained primarily in biological rather than psychological interventions.) If not, ask him or her for a referral to a psychologist or other qualified professional. Good luck.