Cardiovascular disease and depression: Caring for the brokenhearted

Over the last decades, the association between depression and cardiovascular disease has received a lot of attention. The effect of depression has been studied along two separate lines of research: both as a risk factor for the onset of cardiovascular disease in initially healthy persons (showing markedly increased mortality rates), and as a risk factor for cardiovascular disease progression in patients with already manifest disease, particularly coronary artery disease (showing both that the prevalence of depression is increased in coronary artery disease patients, and that depression is a risk factor for cardiac events in patients with coronary artery disease). By now it is thus well established that depression is a risk factor for the onset and progression of cardiovascular disease, but intervention studies have failed to show that treating depression can counter these effects. Pertinent issues in this field of research include the question whether the association between depression and heart disease is causal, what the underlying mechanisms are that explain the association (the two pathophysiological mechanisms that have attracted most of the attention are altered autonomic nervous system activity and inflammatory processes), how clinicians should best treat depressed heart disease patients, and whether the association is unique with respect to depression, or should be extended to different forms of psychological distress.