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Cardiovascular Psychiatry and Neurology
Volume 2013 (2013), Article ID 695925, 14 pages
http://dx.doi.org/10.1155/2013/695925
Review Article

Depression and Cardiac Disease: Epidemiology, Mechanisms, and Diagnosis

1Harvard Medical School, Boston, MA 02114, USA
2Department of Psychiatry, Massachusetts General Hospital, Blake 11, 55 Fruit Street, Boston, MA 02114, USA
3Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA

Received 29 January 2013; Accepted 18 March 2013

Academic Editor: Kenji Hashimoto

Copyright © 2013 Jeff C. Huffman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors—including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities—may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.