Depression and heart disease: what do we know, and where are we headed?

Depression and heart disease have an intricate associa- tion and perhaps a causal relationship. We review the current status of depression and heart disease and pro- vide an algorithm for diagnosing and treating depression in cardiac patients that internists and cardiologists can use in their daily patient encounters. KEY POINTS ■ ■ Depression is a risk factor for new cardiac disease and has a detrimental impact in established cardiac disease. Numerous mechanistic pathways have been implicated. In clinical trials, drug therapy and psychotherapy have not clearly decreased the rate of cardiac death in de- pressed cardiac patients, but they did improve depres- sion, adherence to drug therapy, and quality of life.